Director Product Pharmacy Claims Platform

Role overview Lead product direction for core pharmacy claims adjudication and transaction capabilities. This hands-on role connects product, engineering, operations, clinical, and finance teams to deliver accurate, scalable processing and improve how pharmacy benefit transactions affect members, pharmacies, clients, and financial results.

Responsibilities - Own the roadmap and priorities for adjudication platform capabilities, balancing business needs, operational requirements, and technical constraints. - Define requirements across the claims lifecycle, including eligibility, benefit configuration, pricing, clinical edits, member cost share, accumulators, and financial reconciliation. - Partner with engineering on platform capabilities, APIs, data models, configurable rules, and integrations that support reliable high-volume processing. - Lead initiatives from requirements through production, resolving competing needs and ensuring validation, transaction accuracy, and operational readiness. - Use transaction and operational data to diagnose issues, measure performance, and guide product improvements. - Account for privacy, security, compliance, and auditability in product decisions and communicate tradeoffs to technical and executive audiences.

Requirements - At least eight years in product management or a related platform role, including three or more years directly accountable for requirements, priorities, and production delivery for a pharmacy claims adjudication engine or substantial core capabilities. - Deep knowledge of pharmacy benefit manager operations and the pharmacy claims lifecycle, including pricing, member cost share, accumulators, and downstream financial effects. - Hands-on understanding of pharmacy transaction processing, including rejects, reversals, resubmissions, coordination of benefits, and processing at scale. - Ability to translate complex processing rules into clear product requirements, acceptance criteria, and test scenarios, with strong technical product judgment. - Proven cross-functional leadership delivering complex platform initiatives through production and improving results with data.

Nice to have - Direct responsibility for operating or supporting production adjudication platforms and troubleshooting complex claims issues. - Experience with phased releases, platform integrations, commercial and government benefits, or payment settlement workflows. - Bachelor’s degree in a relevant field or equivalent experience.

Benefits and work setup - Flexible time off, 12 paid holidays, employer-paid medical, dental, and vision premiums, a 401(k) match, health savings account contribution, and stock options. - Published projected salary range: $177,500–$222,500 annually; final offers consider experience, interview feedback, internal equity, and location.