Pega Consultant with Pega Product Composer System

Key Responsibilities

• Configure and manage healthcare insurance products, benefits, plans, and rules using Pega PCS.
• Work closely with business stakeholders, SMEs, product owners, and technical teams to understand product requirements and translate them into PCS configurations.
• Support analysis, design, build, validation, and implementation of healthcare payer products within the PCS platform.
• Review benefit structures, plan designs, riders, limits, accumulators, cost shares, exclusions, and eligibility rules.
• Participate in requirement discussions, grooming sessions, design reviews, sprint planning, and daily stand-ups.
• Ensure PCS configurations align with business rules, regulatory requirements, and downstream system needs.
• Support integration discussions between PCS and claims, enrollment, provider, billing, and downstream adjudication systems.
• Perform configuration unit testing and support QA/UAT teams during validation cycles.
• Identify configuration defects, perform root cause analysis, and coordinate resolution with relevant teams.
• Prepare and maintain functional specifications, configuration documents, mapping documents, test scenarios, and traceability artifacts.
• Collaborate with Pega architects, developers, business analysts, testers, and client SMEs to ensure timely and quality delivery.
• Support migration, release management, and deployment activities related to PCS configurations.
• Provide subject matter expertise on PCS best practices and healthcare payer product implementation.

Required Skills & Experience

• Strong hands-on knowledge of Pega PCS / Pega Product Composer System.
• Experience in healthcare payer domain, preferably with product, benefit, plan, and group configuration.
• Understanding of healthcare insurance concepts such as:
• Benefit plans
• Medical, pharmacy, dental, or vision benefits
• Copay, coinsurance, deductible, out-of-pocket maximum
• Accumulators
• Eligibility rules
• Nets and provider tiers
• Claims adjudication rules
• Ability to analyze product requirements and convert them into PCS configuration specifications.
• Experience working with Agile/Scrum delivery teams.
• Strong analytical, problem-solving, and communication skills.
• Ability to collaborate with business SMEs, technical teams, QA teams, and project leadership.
• Good understanding of end-to-end healthcare payer processes including enrollment, product setup, benefits, claims, and member/provider servicing.
• Experience in defect triage, issue resolution, and configuration validation.