Director, Product Pharmacy Claims Platform

Prescryptive Health, Inc.

. Own product direction, roadmap, and priorities for core pharmacy adjudication and transaction capabilities .

Posted 10/19/2026full-timeRemote • United States, AustraliaLead💰 $177,500 - $222,500 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in product management for pharmacy adjudication platforms, with a strong focus on translating complex business rules into actionable product requirements and ensuring operational readiness. Proven ability to lead cross-functional teams and drive product initiatives that enhance transaction accuracy and improve business outcomes.

Highest-signal resume keywords

Pharmacy Claims AdjudicationProduct Requirements DefinitionAPIs and Data ModelsTransaction Data AnalysisFinancial Reconciliation

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Product ManagementPharmacy Claims LifecycleNCPDP TransactionsHigh-Volume Transaction SystemsConfigurable RulesAcceptance Criteria DevelopmentTesting ScenariosAdjudication Platform EnhancementsIntegration DeliveryPharmacy Payment Processes

Soft Skills

Effective CommunicationCross-Functional CollaborationDecision-MakingProblem-SolvingAccountability

Industry Keywords

Pharmacy Benefit Manager (PBM) OperationsComplianceAuditabilityHealthcareGovernment Pharmacy Benefits

About the role

Key responsibilities & impact

Own product direction, roadmap, and priorities for core pharmacy adjudication and transaction capabilities
Define requirements across the pharmacy claims lifecycle, including eligibility, benefit configuration, pricing, clinical edits, member cost share, accumulators, and financial reconciliation
Partner with engineering to shape platform capabilities, interfaces, and integrations
Bring together technical and business teams, resolve competing requirements, make tradeoffs, and drive decisions and accountability
Move capabilities from requirements through production while ensuring transaction accuracy, validation, and operational readiness
Use processing performance, transaction data, and operational metrics to identify opportunities and guide improvements
Connect product decisions to business and customer outcomes
Report to the Chief Product Officer
Collaborate with Product, Engineering, Operations, Clinical, Finance, and other teams

Requirements

What you’ll need

At least 8 years in product management or related platform roles
At least 3 years directly accountable for product requirements, priorities, and production delivery of a pharmacy claims adjudication engine or substantial core adjudication platform capabilities
Strong working knowledge of pharmacy claims adjudication, PBM operations, and the full transaction lifecycle
Hands-on understanding of NCPDP transactions, including rejects, reversals, resubmissions, coordination of benefits, and claims processing at scale
Ability to translate complex business and processing rules into product requirements, acceptance criteria, and testing scenarios
Technical fluency in APIs, data models, configurable rules, and high-volume transaction systems
Experience leading complex product initiatives from requirements through production
Ability to use transaction data and operational metrics to diagnose problems and improve outcomes
Ability to communicate effectively with technical and executive audiences
Ability to incorporate privacy, security, compliance, and auditability requirements into product decisions
Experience operating or supporting production pharmacy adjudication platforms
Experience delivering adjudication platform enhancements, integrations, and phased releases
Experience across commercial and government pharmacy benefits
Experience with pharmacy payment processes, financial reconciliation, and settlement workflows
Bachelor's degree in business, healthcare, engineering, computer science, or a related field, or equivalent relevant experience

Benefits

Comp & perks

Flexible time off, including 12 paid holidays
401(k) match
100% employer-paid medical, dental, and vision premiums
Company contribution to Health Savings Account
Stock options
Opportunity to grow alongside an early-stage company working to change a large, complex, and highly consequential industry