Pega Healthcare Claims System Analy...

Themesoft Inc is seeking a Pega Healthcare Claims System Analyst for a contract role supporting healthcare claims processing initiatives. The analyst will gather and document requirements, work with stakeholders and technical teams, support claims workflows and Facets modules, and assist with Agile delivery, testing, and production issue analysis. Responsibilities: - Gather, analyze, and document business and system requirements for healthcare claims processing initiatives - Work closely with business stakeholders, product owners, developers, and QA teams to ensure requirements are accurately defined and implemented - Analyze healthcare claims workflows including claims intake, adjudication, adjustments, provider reimbursement, and payment processing - Work with Facets modules including Claims, Membership, Billing, and Provider to support end-to-end claims lifecycle management - Translate business requirements into functional specifications, user stories, process flows, and acceptance criteria - Analyze member, provider, claims, benefits, and authorization data to support operational and system enhancement initiatives - Support Agile development activities including backlog grooming, sprint planning, testing, defect triage, and release activities - Participate in requirements workshops, stakeholder discussions, and solution design reviews - Support User Acceptance Testing (UAT), validate business requirements, and assist with production issue analysis - Ensure healthcare claims requirements and workflows align with HIPAA and EDI 837/835 transaction standards Must Have: - Healthcare Claims Processing - Pega - Facets (Claims, Membership, Billing, Provider) - EDI 837/835 - Business Analysis - Applicants must be legally authorized to work in the United States Skills: Healthcare Claims Processing, Pega, Facets (Claims, Membership, Billing, Provider), EDI 837/835, Business Analysis, Applicants must be legally authorized to work in the United States Benefits: Remote work