Pega Developer

Job Title: Senior Pega Developer – Healthcare

Location: [Location / Remote / Hybrid]
Experience: 5+ years
Employment Type: Full-Time / Contract

Job Summary

We are seeking an experienced Senior Pega Developer with strong hands-on experience in Pega application development and a solid background in the Healthcare/Health Insurance domain. The ideal candidate will be responsible for designing, developing, configuring, testing, and supporting Pega-based applications that automate healthcare business processes and workflows.

The candidate should have experience working with healthcare processes such as Member, Provider, Claims, Enrollment, Authorization, Benefits, Appeals & Grievances, and Care Management.

Key Responsibilities

• Design, develop, configure, and maintain applications using Pega Platform.
• Develop and customize Pega case management, workflows, business rules, integrations, and user interfaces.
• Translate healthcare business requirements into scalable Pega solutions.
• Work closely with Business Analysts, Product Owners, QA teams, and healthcare stakeholders.
• Develop Pega case types, data objects, decision tables, decision trees, activities, report definitions, and SLAs.
• Configure Pega UI using Views, Sections, Harnesses, and Cosmos/Constellation, based on the Pega version.
• Develop and maintain integrations using REST, SOAP, APIs, JSON, XML, and other enterprise integration technologies.
• Work with healthcare-related data and systems involving members, providers, claims, enrollment, eligibility, benefits, and authorizations.
• Participate in application design, development, unit testing, code reviews, deployment, and production support.
• Troubleshoot production issues and perform root-cause analysis.
• Optimize application performance and follow Pega development best practices.
• Collaborate with offshore/onshore development and QA teams in an Agile/Scrum environment.
• Prepare technical documentation and support knowledge-transfer activities.

Required Skills

• 5+ years of Pega development experience.
• Strong hands-on experience with Pega Platform / Pega PRPC.
• Experience with Pega Case Management and Workflow.
• Strong understanding of Pega Rules, Data Pages, Data Transforms, Activities, Decision Tables, SLA, Reports, and Security.
• Experience developing REST/SOAP integrations and APIs.
• Strong SQL/database knowledge.
• Experience with Agile/Scrum methodologies.
• Strong troubleshooting and debugging skills.
• Excellent communication and analytical skills.

Healthcare Domain Experience

Candidates should have experience in Healthcare IT / Health Insurance, preferably with one or more of the following:

• Member Enrollment & Eligibility
• Provider Management
• Claims Processing
• Prior Authorization
• Benefits Administration
• Appeals & Grievances
• Care Management
• Utilization Management
• Provider/Member Portals
• Healthcare CRM or Case Management
• HIPAA and healthcare data privacy requirements
• Health plan / payer systems

Preferred Qualifications

• Pega Certified System Architect (CSA) certification.
• Pega Certified Senior System Architect (CSSA) certification.
• Experience with Pega Decisioning or Customer Decision Hub.
• Experience with Pega Integration Services.
• Knowledge of healthcare standards such as FHIR, HL7, EDI/X12 is a plus.
• Experience with cloud environments such as AWS or Azure is a plus.
• Experience with CI/CD and DevOps tools is preferred.

Pay: $50.00 - $70.00 per hour

Application Question(s):

• Max rate is 50-70/hr in 1099 or W2. Are you fine with it?

Work Location: Remote