Sr. Pega Engineer

Sr. Pega Engineer

Location:

Dallas, Texas Type:
Direct Hire

Lead the technical assessment and migration of applications from Pega Smart Claims Engine (SCE) to core/custom Pega PRPC.

Analyze the existing SCE implementation and identify out-of-the-box SCE capabilities, client-specific extensions and customizations, claims processing and adjudication rules, framework dependencies, data model dependencies, integration dependencies, and reusable versus replaceable components.

Develop the SCE to PRPC migration strategy and technical roadmap.

Define the target PRPC application architecture, including enterprise class structure, application hierarchy, rulesets, case types, data model, security model, and integration architecture.

Reengineer SCE-specific functionality using standard Pega Platform capabilities where appropriate.

Identify obsolete or redundant SCE components and recommend rationalization rather than simply lift and shift migration.

Develop migration patterns and reusable components to accelerate the transformation.

Support phased migration, coexistence, parallel processing, and cutover strategies.

Design scalable and reusable Pega PRPC applications following Pega Guardrails and architecture best practices.

Define and implement enterprise class structure, application and ruleset architecture, case types and stages, flows and flow actions, data pages and data transforms, activities, decision tables and decision trees, declarative rules, validation rules, SLAs, queue processors, and security.

Review existing SCE rules and determine whether they should be migrated, redesigned, replaced, or retired.

Conduct architecture, design, and code reviews.

Ensure migrated applications meet performance, scalability, maintainability, security, and Pega Guardrail requirements.

Apply strong understanding of healthcare claims processing throughout the migration.

Work with business SMEs to understand and reengineer functionalities such as claims intake, validation, adjudication, auto adjudication, claims edits, benefit and eligibility validation, provider/member information, pricing/payment workflows, claim exceptions, routing, pend/review workflows, and reprocessing.

Translate existing SCE claims functionality into appropriate PRPC case management, decisioning, and business rule capabilities.

Analyze and redesign integrations between Pega and healthcare systems using REST APIs, SOAP Web Services, JSON/XML, JMS, IBM MQ, database integrations, and file-based interfaces.

Support migration and mapping of claims data, ensuring proper error handling, exception processing, reconciliation, and monitoring.

Develop validation strategies to ensure functional equivalence between SCE and PRPC applications.

Support testing phases including unit, system integration, regression, UAT, performance, and parallel claims processing.

Work closely with SMEs and QA teams to validate claim outcomes; troubleshoot issues using Pega diagnostic tools.

Provide technical leadership to Pega developers and migration teams.

Create high-level and low-level design, migration architecture, and technical specs.

Perform estimations, mentor developers, and establish standards.

Collaborate across teams including enterprise architects, business architects, product owners, healthcare SMEs, QA, Dev Ops, and infrastructure.

Participate in agile ceremonies and identify technical risks with mitigation strategies.

10+ years of hands-on Pega PRPC experience.

5+ years of Pega Smart Claims Engine (SCE) experience preferred.

Demonstrated experience migrating, modernizing, or reengineering Pega SCE/framework applications into core/custom Pega PRPC solutions.

Strong hands-on experience with Pega 8.x or newer platform versions.

Deep knowledge of enterprise class structure, ruleset architecture, case management, data pages, data modeling, decision rules, declarative processing, activities, background processing, security, reporting, and performance optimization.

Strong knowledge of Pega Guardrails and development best practices.

Experience with application migration, deployment, and release management.

Strong healthcare payer domain knowledge, with hands-on…