10 hours ago
Atlanta, GA, USAMid Level
Responsibilities
- Design, develop, and configure PEGA applications for healthcare claims processing, adjudication, and workflow automation integrated with Facets.
- Build and customize PEGA case types, flows, decision rules, and UI rules for claims exception handling and manual review.
- Support end-to-end claims lifecycle management across Facets Claims, Membership, Billing, and Provider modules.
- Integrate PEGA with Facets and other core administration systems using REST/SOAP APIs, connectors, and data pages.
- Analyze healthcare claims requirements, including HIPAA, EDI 837/835, and X12 transactions, and translate them into PEGA application designs.
- Collaborate with business analysts, architects, and QA teams to deliver claims applications.
Requirements
- Hands-on experience developing and configuring PEGA applications, including case types, flows, decision rules, and UI rules.
- Experience with Facets Claims, Membership, Billing, and Provider modules supporting healthcare claims processing.
- Working knowledge of EDI 835 and 837 transactions and X12 standards in a HIPAA-compliant environment.
- Experience integrating PEGA with core administration systems through REST/SOAP APIs, connectors, and data pages.
- Proven ability to translate complex healthcare claims business requirements into technical application designs.
- PEGA Certified Senior System Architect certification or equivalent is preferred.
- Healthcare payer or insurance industry experience, experience with additional claims systems, and cross-functional collaboration skills are preferred.
Benefits
- Remote work from anywhere in the United States.
- Medical, dental, vision, and life insurance, subject to eligibility.
- Paid holidays and paid time off.
- 401(k) plan and contributions.
- Long-term and short-term disability coverage.
- Employee Stock Purchase Plan.
- This is a potential future employment opportunity rather than a currently available position.
Tech Stack
SOAP
Categories
About Cognizant
Cognizant is a public IT services and consulting firm that designs, builds, and runs enterprise technology, including digital engineering, cloud modernization, data/AI, and managed services. It sells consulting, systems integration, and outsourcing on multi-year engagements to large enterprises in healthcare, banking, retail, communications, and manufacturing. Founded in 1994 and headquartered in Teaneck, New Jersey, Cognizant is NASDAQ-listed (CTSH) and a Fortune 500 company.