Pega Systems Analyst

Veriipro; Mason (OH); On-site; USD 90,000 - 120,000; Full time

Job summary

Veriipro is seeking a Pega Systems Analyst in Mason, Ohio, to support initiatives related to claims intake and workflow enhancements. The role involves translating business needs into functional requirements and ensuring system alignment.

The ideal candidate should possess strong experience with the Pega platform and healthcare claims systems, as well as excellent communication skills. You will lead requirements gathering and collaborate on claims processing workflows.

Qualifications

• Strong experience with Pega platform and healthcare claims systems.
• Experience in claims operations, including intake, validation, and pre-adjudication.
• Excellent communication and stakeholder management skills.

Responsibilities

• Lead requirements gathering sessions with stakeholders.
• Develop use cases and functional documentation.
• Collaborate on claims processing workflows.

Skills

Strong experience with Pega platform

Healthcare claims systems

Strong SQL skills

Excellent communication skills

Job description

Role Overview

We are seeking a Pega Systems Analyst with strong healthcare insurance experience to support initiatives focused on claims intake, pre-adjudication validation, and workflow/UI enhancements. The role acts as a liaison between business and IT, translating business needs into functional and technical requirements while ensuring alignment with system capabilities and performance expectations.

Roles and Responsibilities

• Lead requirements gathering sessions with business and technical stakeholders
• Define functional, usability, performance, and support requirements
• Support system design, testing, and implementation activities
• Develop use cases, process flows, and functional documentation using standard tools
• Identify opportunities for process improvement, automation, and workflow optimization
• Support dashboarding and reporting enhancements for claims operations
• Collaborate on inbound claims processing workflows and validation processes

Required Skills & Experience

• Strong experience with Pega platform and healthcare claims systems
• Experience in claims operations, including intake, validation, and pre-adjudication processes
• Familiarity with claims intake platforms (e.g., portal-based intake, EDI/clearinghouse workflows such as Edifecs or similar)
• Experience in healthcare payer or insurance environments
• Strong SQL skills for data analysis and validation
• Ability to translate business requirements into technical specifications
• Excellent communication and stakeholder management skills

Preferred Skills

• Experience supporting workflow/UI enhancements within Pega applications
• Knowledge of claims balancing and adjudication lifecycle processes
• Experience with reporting tools and dashboard development
• Exposure to automation initiatives in claims processing environments