Pega System Analyst – Healthcare
Job Title Pega System Analyst – Healthcare Location Remote / USA Contract 12+ months Job Summary We are seeking an experienced Pega System Analyst with healthcare domain knowledge to analyze business requirements, design workflow solutions, and support the implementation of Pega-based applications. The ideal candidate will work closely with healthcare business stakeholders, product owners, developers, QA teams, and solution architects to deliver efficient healthcare case management and process automation solutions.
Key Responsibilities
Gather, analyze, and document business requirements from healthcare stakeholders. Conduct requirement-gathering sessions, stakeholder interviews, and JAD workshops. Translate business requirements into functional specifications, user stories, acceptance criteria, and process flows. Analyze healthcare workflows involving member enrollment, eligibility, claims processing, prior authorization, provider management, and appeals and grievances. Work with Pega developers and architects to define case types, stages, steps, business rules, SLAs, and routing requirements. Prepare AS-IS and TO-BE process flows and identify opportunities for workflow automation. Maintain and prioritize the product backlog in collaboration with product owners. Support Agile ceremonies, including sprint planning, backlog refinement, daily stand-ups, sprint reviews, and retrospectives. Coordinate with QA teams on test scenarios, test cases, UAT, and defect resolution. Validate that delivered solutions meet business requirements and healthcare regulatory expectations. Support integration requirements involving healthcare systems, APIs, EDI transactions, and external applications. Ensure appropriate handling of protected health information (PHI) and compliance with applicable HIPAA requirements. Prepare functional documentation, business process documents, traceability matrices, and training materials. Support production issue analysis, root-cause investigations, and post-implementation enhancements. Required Skills Experience as a Pega System Analyst, Business Analyst, or Functional Analyst. Strong understanding of Pega Platform and Pega case management concepts. Knowledge of case life cycles, stages, steps, routing, SLAs, decision rules, and business process automation. Healthcare domain experience, preferably in health insurance or payer organizations. Understanding of healthcare claims, member eligibility, benefits, provider networks, prior authorization, and appeals. Experience writing user stories, functional requirements, and acceptance criteria. Knowledge of Agile/Scrum methodologies and tools such as Jira and Confluence. Experience with UAT planning, test execution, defect management, and stakeholder communication. Strong analytical, documentation, problem-solving, and communication skills.