Director, Product Pharmacy Claims Platform

This is a fully remote position, open to applicants in United States, +46 more locations.

📋 Description

• Take ownership of the product direction, roadmap, and priorities for fundamental pharmacy adjudication and transaction functionalities.

• Establish requirements throughout the pharmacy claims lifecycle, covering eligibility, benefit configuration, pricing, clinical edits, member cost share, accumulators, and financial reconciliation.

• Collaborate with engineering teams to influence platform functionalities, interfaces, and integrations.

• Unite technical and business teams, address conflicting requirements, make necessary tradeoffs, and promote decision-making and accountability.

• Transition capabilities from the requirements stage to production while ensuring transaction accuracy, validation, and operational readiness.

• Leverage processing performance, transaction data, and operational metrics to pinpoint opportunities and steer enhancements.

• Align product decisions with business and customer outcomes.

• Report directly to the Chief Product Officer.

• Work in partnership with Product, Engineering, Operations, Clinical, Finance, and other departments.

⛳️ Requirements

• A minimum of 8 years in product management or similar platform roles.

• At least 3 years of direct accountability for product requirements, priorities, and the production delivery of a pharmacy claims adjudication engine or significant core adjudication platform capabilities.

• In-depth knowledge of pharmacy claims adjudication, PBM operations, and the entire transaction lifecycle.

• Practical understanding of NCPDP transactions, including rejects, reversals, resubmissions, coordination of benefits, and large-scale claims processing.

• Capability to convert intricate business and processing rules into product requirements, acceptance criteria, and testing scenarios.

• Technical proficiency in APIs, data models, configurable rules, and high-volume transaction systems.

• Experience in leading intricate product initiatives from requirements through to production.

• Ability to utilize transaction data and operational metrics to identify issues and enhance outcomes.

• Strong communication skills for engaging effectively with both technical and executive stakeholders.

• Proficiency in integrating privacy, security, compliance, and auditability requirements into product decisions.

• Experience in operating or supporting production pharmacy adjudication platforms.

• Proven track record in delivering enhancements, integrations, and phased releases for adjudication platforms.

• Familiarity with both commercial and government pharmacy benefits.

• Experience with pharmacy payment processes, financial reconciliation, and settlement workflows.

• A bachelor's degree in business, healthcare, engineering, computer science, or a related field, or equivalent relevant experience.

🏝️ Benefits

• Flexible time off, including 12 paid holidays.

• 401(k) matching program.

• 100% employer-covered medical, dental, and vision premiums.

• Company contribution towards Health Savings Account.

• Stock options.

• Opportunity for growth within an early-stage company aiming to transform a large, complex, and significantly impactful industry.