Sr. Pega Engineer

About the role

The Sr. Pega Engineer will lead the technical assessment and migration of applications from Pega Smart Claims Engine (SCE) to core/custom Pega PRPC. The role involves analyzing existing SCE implementations, defining PRPC application architecture, reengineering SCE-specific functionality, and ensuring migrated applications meet performance, scalability, and security requirements.

Responsibilities

• Analyze the existing SCE implementation and identify out-of-the-box capabilities, client-specific extensions, and customizations.
• 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 simple 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.
• 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.
• 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.
• 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.
• Collaborate 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.
• Mentor developers and establish standards.
• Collaborate across teams including enterprise architects, business architects, product owners, healthcare SMEs, QA, DevOps, and infrastructure.
• Participate in agile ceremonies and identify technical risks with mitigation strategies.

Requirements

• 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 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 experience in healthcare claims processing, adjudication, and auto adjudication.
• Understanding of claims data, eligibility, benefits, provider/member info, and payments.
• Experience with healthcare claims platforms and integration ecosystems.
• Knowledge of healthcare security and regulatory requirements.
• Strong experience with REST, SOAP, JSON/XML, IBM MQ/JMS, SQL, Oracle/SQL Server.
• 10+ years of Pega PRPC experience; 5+ years of SCE experience preferred.
• Pega Certified Senior System Architect (PCSSA/CSSA) – strongly preferred.
• Pega Lead System Architect (CPLSA) certification highly desirable.
• Previous Pega SCE to PRPC migration experience preferred.
• Experience with healthcare frameworks and legacy modernization.
• Knowledge of Pega Constellation, CI/CD, and Pega DevOps is a plus.
• Ability to lead globally distributed teams and drive technical decisions.
• Strong analytical, problem-solving, stakeholder communication skills, and ability to work independently.

Benefits

System One offers comprehensive benefits including medical, dental, vision, spending accounts, life insurance, voluntary plans, and participation in a 401(k) plan. System One is an Equal Opportunity Employer.