Hih- Software Engineering Lead Analyst

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 OptumRx 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