Pega Developer – Healthcare

Job Description

We are looking for an experienced Pega Developer with strong Healthcare/Payer domain experience to support enterprise healthcare applications for Elevance Health.

The ideal candidate will have 6+ years of overall IT/Pega development experience, with hands-on expertise in designing, developing, integrating, and supporting applications using the Pega Platform / Pega PRPC.

The candidate should have a solid understanding of healthcare payer processes, particularly claims processing, eligibility, prior authorization, member/provider workflows, and healthcare integrations.

Pega experience is particularly relevant to Elevance Health’s healthcare applications and claims-related automation.

Key Responsibilities

• Design, develop, configure, test, and maintain applications using Pega PRPC / Pega Infinity.
• Develop case types, workflows, flows, activities, data transforms, data pages, decision tables, business rules, UI components, and SLAs.
• Translate healthcare business requirements into scalable Pega solutions.
• Develop and support integrations using REST/SOAP APIs, JSON, XML, web services, and database connections.
• Work on healthcare workflows involving claims processing/adjudication, eligibility, prior authorization, member and provider services, appeals/grievances, and exception handling.
• Troubleshoot application and production issues using Pega tools such as Tracer, PAL, Clipboard, and DB Trace.
• Perform code reviews and ensure development follows Pega guardrails and best practices.
• Participate throughout the SDLC, including requirements analysis, design, development, unit testing, SIT/UAT support, deployment, and production support.
• Collaborate with Business Analysts, Product Owners, Architects, QA, integration teams, and healthcare SMEs in an Agile/Scrum environment.

Required Skills

• 6+ years of IT/Pega development experience.
• Strong hands-on experience with Pega PRPC / Pega Infinity.
• Strong understanding of Pega Case Management and BPM/workflow development.
• Experience with Pega rules, flows, activities, data pages, data transforms, decisioning, and UI development.
• Healthcare/Payer domain experience is required.
• Knowledge of healthcare claims, claims adjudication, eligibility, prior authorization, member/provider, or appeals workflows.
• Strong integration experience with REST/SOAP APIs and web services.
• Good knowledge of SQL and relational databases such as Oracle or SQL Server.
• Experience debugging, troubleshooting, and performance-tuning Pega applications.
• Experience working in Agile/Scrum delivery environments.
• Strong communication and analytical/problem-solving skills.

Preferred Skills

• Pega CSSA (Certified Senior System Architect) certification preferred; CSA/CLSA certification is a plus.
• Experience with Pega Healthcare Industry Foundation (HCIF), Pega Smart Claims Engine, or healthcare-specific Pega frameworks.
• Knowledge of healthcare standards such as HIPAA, X12 EDI (837/835/270/271), HL7, or FHIR.
• Experience integrating Pega with healthcare claims platforms such as Facets is a plus.
• Experience with AWS/Azure, CI/CD, Jenkins/Git, or DevOps practices.
• Java/J2EE experience is an added advantage.

Must-Have Skills

• Pega Development
• 6+ Years Experience
• Healthcare/Payer Domain
• Claims/Eligibility/Prior Authorization
• REST/SOAP APIs
• SQL
• Agile
• Pega CSSA certification and healthcare claims experience are strongly preferred.