Pega Systems Analyst - Healthcare Claims

SOMERSET STAFFING

Mason, OH

JOB DETAILS
SKILLS
Adjudication, Analysis Skills, Automation, Background Investigation, Business Skills, Claims Processing, Communication Skills, Documentation Standards, Healthcare, Insurance, Process Development, Reporting Dashboards, Reporting Skills, Requirements Management, SQL (Structured Query Language), Systems Analysis, Test Design, Usability Engineering, Use Cases, User Interface/Experience (UI/UX)
LOCATION
Mason, OH
POSTED
2 days ago

We are seeking a Pega System Analyst with strong healthcare insurance experience to support the PEGA initiative focused on claims intake, pre-adjudication validation, and workflow/UI enhancements. The role serves as a key liaison between business and IT, defining functional, usability, performance, and support requirements while ensuring technical solutions align with business needs. Required Skills - PEGA, Healthcare Claims Job Duties - Responsibilities include leading requirements gathering, assisting with system design, supporting testing and implementation, and developing use cases and documentation using standard tools. The analyst will also help identify process efficiencies and opportunities for automation, including dashboard development and reporting enhancements. Job Requirements - Experience with Pega, claims operations (including Edifecs/portal intake and balancing), and healthcare payer environments such as Anthem, Beacon Health Options, or ValueOptions is highly preferred. Strong communication skills and the ability to translate business needs into technical requirements are essential. Experience in inbound claims processing and SQL skills. Desired Skills & Experience - Experience with Pega, claims operations (including Edifecs/portal intake and balancing), and healthcare payer environments such as Anthem, Beacon Health Options, or ValueOptions is highly preferred. Strong communication skills and the ability to translate business needs into technical requirements are essential.

Required Skills :

Basic Qualification :

Additional Skills :

Background Check : No

Drug Screen : No

About the Company

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SOMERSET STAFFING