Senior Product Manager, PBM Platform

This is a fully remote position, open to applicants in New York.

📋 Description

• Take ownership of the vision, roadmap, and delivery strategy for claims adjudication, ensuring scalability with increasing volume, new clients, and additional lines of business.

• Develop in-depth knowledge of pharmacy claims adjudication, encompassing eligibility, coverage rules, pricing, rejections, overrides, and coordination of benefits, and translate this into a structured, prioritized plan.

• Establish the long-term strategy for platform advancement to accommodate operational scalability, regulatory compliance, and new business lines, including Medicare.

• Create specifications, user stories, and acceptance criteria; facilitate backlog refinement, sprint planning, and release coordination within an agile framework.

• Collaborate with the adjudication engineering team to prioritize tasks, manage dependencies, and clarify uncertainties in claim behavior.

• Set standards for correctness and oversee testing and claim certification to ensure production readiness.

• Manage the planning for readiness and rollout, including validation against actual claim volume, parallel testing, and phased releases.

• Oversee go-live readiness across operations, clinical, client success, and compliance departments.

• Collaborate with PBM operations, clinical, legal, and client success teams to fulfill workflow and regulatory obligations.

• Handle drug data, formulary, and prior authorization dependencies.

• Define and monitor KPIs related to claim accuracy, system performance, and reliability.

• Serve as the primary product contact for adjudication within the organization and with external partners.

⛳️ Requirements

• A bachelor's degree is required.

• At least 5 years of product management experience, ideally in healthcare or enterprise technology.

• Proficiency with complex, rules-driven transaction processing systems such as claims adjudication, payments, or benefit administration, with accountability for correctness and testing.

• Experience in leading a platform migration or significant system transition from requirements gathering to go-live.

• Demonstrated ability to spearhead cross-functional initiatives that involve product, engineering, legal, and operations stakeholders.

• Capacity to work autonomously and drive execution with minimal supervision.

• Excellent communication skills with a proven ability to collaborate effectively across both technical and non-technical teams.

• Attention to detail and process-oriented, comfortable in a domain where precision is assessed on a claim-by-claim basis.

• Familiarity with navigating complex, data-intensive systems.

• Inquisitive and adaptable, willing to explore unfamiliar and highly technical areas to find solutions.

• Experience in or with PBMs, pharmacy claims, or pharmacy operations is advantageous.

• Understanding of systems that support regulated healthcare markets, including Medicare, is beneficial.

• Knowledge of pharmacy-related data standards such as NCPDP or Medi-Span is a plus.

• Exposure to APIs, system integrations, or healthcare data platforms is an asset.

• An advanced degree in a relevant field (MBA, MPH, or a technical degree) is a plus.

🏝️ Benefits

• Bonus

• Equity