Description

Lead Pega Customer Service implementations for healthcare contact center environments, owning the design and deployment of member services, claims, eligibility, prior authorization, appeals, and provider interaction workflows.

This role is on-site.

Responsibilities

• Lead end-to-end implementation of Pega Customer Service solutions tailored to healthcare use cases.
• Design and manage complex workflows for member services, claims processing, eligibility checks, prior authorization, and appeals.
• Ensure technical architectures align with healthcare industry standards and contact center operational requirements.
• Manage provider interactions and integration points within the Pega platform.

Required Skills

• Pega Certified Lead System Architect (CLSA) certification is mandatory.
• 5+ years of hands-on experience with Pega Customer Service, specifically in healthcare domains.
• Deep expertise in healthcare workflows including claims, eligibility, and prior authorization.
• Proven track record in Healthcare Contact Center implementations.
• Bachelor’s degree in any discipline (Any Graduate).

Preferred Skills

• US Healthcare Payer/Provider domain knowledge (Medicare, Medicaid, or Commercial).
• Cloud experience with AWS, Azure, or GCP.
• Knowledge of HIPAA compliance and Protected Health Information (PHI) handling.

Key Skills

Education

Any Graduate