ABOUT EVERNORTH:

Evernorth℠ exists to elevate health for all, because we believe health is the starting point for human potential and progress. As champions for affordable, predictable and simple health care,
we solve the problems others don’t, won’t or can’t.

Our innovation hub in India will allow us to work with the right talent, expand our global footprint, improve our competitive stance, and better deliver on our promises to stakeholders. We are passionate about making healthcare better by delivering world-class solutions that make a real difference.

We are always looking upward. And that starts with finding the right talent to help us get there.

Job Summary:

We are looking for an experienced Pega Lead Developer with deep expertise in the Pharmacy Prior Authorization (Rx PA) domain. The ideal candidate will lead the design and development of Pega-based solutions to streamline and automate the prior authorization process, ensuring compliance with healthcare regulations and improving member and provider experiences.

Key Responsibilities:

• Lead the end-to-end design, development, and deployment of Pega applications focused on Rx Prior Authorization workflows.

• Collaborate with clinical, business, and IT stakeholders to gather and analyze requirements specific to drug coverage, formulary rules, and utilization management.

• Architect scalable and compliant solutions using Pega PRPC, Pega Healthcare frameworks, and decisioning capabilities.

• Integrate Pega with external systems such as pharmacy benefit managers (PBMs), claims adjudication systems, and electronic health records (EHRs).

• Mentor junior developers and conduct code reviews to ensure quality and performance.

• Drive automation of manual processes such as clinical review routing, real-time benefit checks, and appeals management.

Required Skills and Qualifications:

• Bachelor’s or master’s degree in computer science, Engineering, or a related field.

• 6+ years of Pega development experience, with at least 2 years in a lead role.

• Strong domain knowledge of Pharmacy Prior Authorization, Formulary Management, and Utilization Review.

• Pega CSSA or CLSA certification.

• Experience with Pega Healthcare Industry Foundation (HCIF) or similar frameworks.

• Familiarity with HL7, FHIR, NCPDP, and other healthcare data standards.

• Strong understanding of Agile methodologies and DevOps practices.

• Excellent problem-solving, communication, and leadership skills.

Preferred Qualifications:

• Experience working with PBMs like CVS Caremark, Optum Rx, or Express Scripts.

• Experience with Pega Infinity and Pega Cloud.

• Familiarity with REST/SOAP APIs, SQL, and Java.

• Exposure to CI/CD tools and automation frameworks.

• Exposure to real-time benefit tools (RTBT) and electronic prior authorization (ePA) standards.

• Knowledge of clinical decision support systems (CDSS) and AI/ML integration in Pega.

• Experience with cloud platforms (Pega Cloud, AWS, Azure).

Equal Opportunity Statement:

Evernorth is an Equal Opportunity Employer actively encouraging and supporting organization-wide involvement of staff in diversity, equity, and inclusion efforts to educate, inform and advance both internal practices and external work with diverse client populations.

About Evernorth Health Services

Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives.