I did QA for a Pega BPM project at a regulated company, working with an off-site (though on-shore) Pega consulting firm. Aside from the usual big-co version of "agile", and that this was a legacy rewrite, the process was more or less the same as regular C#/Java development.

Funny thing with Pega is once you break out of the normal BPM-style flow, you'll write almost as much code as an all-code platform, just cookie-cuttered into form fields.