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Roles and portals

Updated on December 10, 2021

Pega Smart Claims Engine for Healthcare supports key roles associated with your day-to-day use of the application. The table below describes the key access roles provided with the Pega Smart Claims Engine for Healthcare.

Role Description
Claims Examiner (regular, senior and junior)The claims examiner roles are responsible for resolving suspended claims and other key operational tasks. Different functionality is provided for the different levels of claims examiner role. The claims examiner portal is available for these roles.
Claims Manager The claims manager is responsible for managing claims examiners and team performance, ensuring that examiners meet their SLAs and KPIs. Dashboards are available on this portal showing work statistics and other data points. The claims manager portal is available for this role.
Business Analyst The business analyst is responsible for the configuration of the system, including event codes, action codes, matching criteria and subsequent testing. The business analyst portal is available for this role.
System ManagerThe system manager is responsible for approving system configurations and ensuring that the system is performing correctly. Dashboards are available on this portal to show the performance of the system and the file intake statistics. The system manager portal is available for this role.
Test AnalystThe test analyst is responsible for testing the claims engine to ensure that everything configured works correctly. The test analyst portal is available for this role.

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