Director, Pharmacy Claims Platform & Adjudication Lead

Prescryptive Health; United States; On-site; USD 178,000 - 223,000; Full time

Benefits offered by this job

Stock options

401(k) match

Health premiums covered

HSA contribution

Flexible time off

12 paid holidays

Job summary

Prescryptive Health is seeking a Director, Product (Pharmacy Claims Platform) to own adjudication capabilities and drive strategy in a PBM-focused context. You will lead cross-functional teams across engineering, operations, and clinical to deliver reliable, scalable pharmacy transaction technology.

You will translate complex rules into clear product requirements, manage a roadmap, and ensure privacy, security, and auditability while balancing business and customer outcomes.

Qualifications

• 8+ years in product mgmt or platform roles with 3+ years leading pharmacy claims adjudication.
• Deep PBM and claims lifecycle knowledge.
• Knowledge of pharmacy transaction standards (NCPDP).
• Strong technical and product judgment; APIs, data models, high-volume systems.
• Proven cross-functional leadership.

Responsibilities

• Own the product direction for core adjudication and transaction capabilities.
• Define requirements across the claims lifecycle (eligibility, pricing, member cost share, reconciliations).
• Partner with engineering to deliver scalable platform capabilities.
• Lead through complexity and drive clear decisions and accountability.
• Drive delivery from requirements to production and operational readiness.
• Measure results using processing performance and operational metrics.

Skills

Adjudication ownership

PBM expertise

NCPDP knowledge

APIs/data models

Cross-functional leadership

Data-driven decisions

Executive communication

Education

Bachelor's degree

Job description

Prescryptive Health is seeking a Director, Product (Pharmacy Claims Platform) to own adjudication capabilities and drive strategy in a PBM-focused context. You will lead cross-functional teams across engineering, operations, and clinical to deliver reliable, scalable pharmacy transaction technology.

You will translate complex rules into clear product requirements, manage a roadmap, and ensure privacy, security, and auditability while balancing business and customer outcomes.