Lead Pega Business Systems Analyst

**Job Title: Lead Pega Business Systems Analyst (Medicaid Eligibility & Enrollment)** **Position Overview:** We are seeking a highly seasoned Lead Technical Functional Analyst / Business Systems Analyst with over 15 years of experience to spearhead the modernization and support of our large-scale Medicaid system. In this strategic, high-impact role, you will serve as the primary bridge between State Agency stakeholders, Pega Architects, System Integrators, and Developers. The ideal candidate possesses deep domain expertise in Medicaid Eligibility and Enrollment lifecycles combined with strong functional mastery of the Pega platform. You will be responsible for translating complex public health policies into robust technical workflows, driving system stabilization, and leading cross-functional teams through rigorous testing and production deployment. **Key Responsibilities:** *Functional Design & Domain Leadership* - Translate Policy to Workflows: Map complex Medicaid rules into Pega workflows, covering Eligibility Determination, Enrollment Lifecycle Management, and Renewals/Redeterminations. - Rules & Benefit Management: Define and document business logic for benefit stacking, case management workflows, and automated consumer notices/correspondence. - Stakeholder Liaison: Act as the critical interface between non-technical State Agency stakeholders and highly technical delivery teams (Architects, Developers, and System Integrators). *Pega Technical Analysis* - Solution Architecture Collaboration: Partner with Pega Architects to design stage-based Case Management models, routing/assignment rules, and complex Decision Rules (Decision Tables, Trees, and When-Rules). - System Integration: Define for secure backend integrations and interfaces connecting Pega to external state and federal data sources. *Testing, Triage & Production Support* - Testing Oversight: Drive User Acceptance Testing (UAT) and System Integration Testing (SIT) strategy, ensuring system alignment with federal and state Medicaid mandates. - Defect Triage: Lead root cause analysis (RCA) for complex system defects, managing triage efforts during critical launch and stabilization phases. - Data-Driven Insights: Utilize SQL to query backend relational databases and build Power BI dashboards to track operational metrics, system health, and processing bottlenecks. ** Qualifications & Experience:** - Experience: 15+ years of progressive experience as a Business Systems Analyst, Technical Functional Analyst, or Product Owner in enterprise IT environments. - Domain Expertise: Mandatory background in government programs, specifically managing Medicaid Eligibility & Enrollment lifecycles. - Pega Experience: Deep functional knowledge of the Pega platform, including Case Management, Workflows, Decisioning, Routing, and Integration interfaces. - Scale: Proven track record supporting large-scale, multi-tier enterprise systems with complex regulatory compliance rules. - Testing & Stabilization: Hands-on experience with defect triage, root cause analysis, SIT, UAT, and hypercare/production stabilization. **Preferred Technical Skills & Certifications:** - Pega Certifications: Pega Business Architect (PBA) or Certified System Architect (CSA) is highly preferred. - Data Tools: Strong proficiency in writing SQL queries and building visual reports in Power BI.