Pega Smart Claims
3 days ago
Key Responsibilities
- Design, develop, and implement solutions on Pega Smart Claims platform for insurance/healthcare domain.
- Configure and customize Pega rules, flows, case types, data pages, activities, decision tables, and integrations.
- Work closely with business stakeholders to gather requirements and translate them into functional and technical solutions.
- Enhance and optimize claims processing workflows to improve accuracy and reduce turnaround time.
- Perform unit testing, debugging, and defect resolution for Pega Smart Claims applications.
- Collaborate with cross-functional teams (QA, Business Analysts, Architects) to deliver high-quality solutions.
- Provide production support and resolve issues within SLAs.
- Ensure compliance with Pega best practices and coding standards.
Required Skills
- Minimum 5 years of hands-on experience in Pega PRPC with focus on Smart Claims (Healthcare/Insurance domain preferred).
- Strong knowledge of Pega Case Management, BPM concepts, and Claims processing workflows.
- Experience with integrations (SOAP/REST APIs, MQ, Web Services).
- Good understanding of claims adjudication, provider/member data, and insurance domain processes.
- Knowledge of Pega Guardrails, Ruleset Management, and Application Lifecycle Management (ALM).
- Familiarity with Agile methodology and DevOps tools for CI/CD in Pega projects.
Good to Have
- Pega certification such as CSA (Certified System Architect) or CSSA (Certified Senior System Architect).
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