Job description

Our client, an IT Services and Consulting company, is looking for a Pega Healthcare Claims Developer – Facets / EDI 835/837 for their Remote location. Responsibilities: • Pega Developer with experience in Designing, developing and configuring Pega applications for Healthcare Claims processing. Skilled in building flows in Pega, integrating with application called Facets and analyzing and translating the business requirements. • Design, develop, and configure Pega applications for healthcare claims processing, adjudication, and workflow automation integrated with Facets. • Work on Facets modules (Claims, Membership, Billing, Provider) to support end-to-end claims lifecycle management including intake, adjudication, and payment processing. • Build and customize Pega case types, flows, decision rules, and UI rules to automate claims exception handling and manual review processes. • Integrate Pega with Facets and other core administration systems using REST/SOAP APIs, connectors, and data pages. • Analyze and translate healthcare claims business requirements (HIPAA, EDI 837/835, X12 transactions) into Pega application design. Requirements: • Required Skills: • Pega • Facets (Claims, Membership, Billing, Provider) • EDI 835, 837 • Good collaboration with business and other teams • Experienced in collaborating with business analysts, architects, and QA teams to deliver high quality applications. • Years of Experience: 8+ Years of Experience Why Should You Apply? • Health Benefits • Referral Program • Excellent growth and advancement opportunities

Requirements

Must-haves

Our client, an IT Services and Consulting company, is looking for a Pega Healthcare Claims Developer – Facets / EDI 835/837 for their Remote location.
Design, develop, and configure Pega applications for healthcare claims processing, adjudication, and workflow automation integrated with Facets.
Work on Facets modules (Claims, Membership, Billing, Provider) to support end-to-end claims lifecycle management including intake, adjudication, and payment processing.
Build and customize Pega case types, flows, decision rules, and UI rules to automate claims exception handling and manual review processes.
Integrate Pega with Facets and other core administration systems using REST/SOAP APIs, connectors, and data pages.
Analyze and translate healthcare claims business requirements (HIPAA, EDI 837/835, X12 transactions) into Pega application design.
Facets (Claims, Membership, Billing, Provider)
Good collaboration with business and other teams
Experienced in collaborating with business analysts, architects, and QA teams to deliver high quality applications.
Years of Experience: 8+ Years of Experience
Why Should You Apply?
Referral Program
Excellent growth and advancement opportunities

Nice-to-haves

None flagged.

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Use the role’s language and application details while tailoring your materials.

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Platform: jobdiva
Effort: medium