Facets – Claims, Membership, Billing, and Provider
EDI 835 / 837 and X12 transactions
Healthcare claims processing and adjudication
Pega integration with Facets and other core administration systems
REST/SOAP APIs, connectors, and Data Pages
Strong ability to collaborate with Business Analysts, Architects, QA, and business stakeholders
Job Description Seeking a Pega Senior System Architect (SSA) / Developer with 8+ years of experience in Pega and strong healthcare domain knowledge, particularly claims processing and Facets integration. The role will focus on designing, developing, and configuring Pega applications that support healthcare claims processing, adjudication, exception handling, and workflow automation.
Key Responsibilities
Design, develop, and configure Pega applications for healthcare claims processing, adjudication, and workflow automation integrated with Facets.
Work with Facets Claims, Membership, Billing, and Provider modules to support the end-to-end claims lifecycle, including intake, adjudication, and payment processing.
Build and customize Pega case types, flows, decision rules, and UI rules for 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 into Pega application designs.
Work with HIPAA, EDI 837/835, and X12 transactions within healthcare claims workflows.
Collaborate closely with Business Analysts, Architects, QA teams, and business stakeholders to understand requirements and deliver high-quality applications.
Troubleshoot application and integration issues and support the overall claims processing workflow.
Must-Have Experience
8+ years of Pega development experience
Strong Pega application development/configuration
Hands-on experience with Facets
Experience with Facets Claims, Membership, Billing, and Provider
Strong understanding of healthcare claims processing/adjudication
Experience with EDI 835 and 837 / X12
Pega integration using REST/SOAP APIs
Experience translating healthcare business requirements into Pega solutions
Strong collaboration and communication skills
Experience: 8+ years
Applicant Notices & Disclaimers
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At SPECTRAFORCE, we are committed to maintaining a workplace that ensures fair compensation and wage transparency in adherence with all applicable state and local laws.This position's pay range is $50.00/hr - $52.14/hr.
