Director Product Pharmacy Claims Platform

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

About Prescryptive

Prescryptive is the healthcare technology company enabling the direct access marketplace for prescription drugs. Our platform aligns incentives so affordability, choice, and patient access become the natural outcome of a functioning system. Learn more about us by following us on LinkedIn or visiting Prescryptive.com.

The Role

We're looking for a Director, Product (Pharmacy Claims Platform) who brings deep experience developing pharmacy claims adjudication technology, understands how it works in a real-world PBM environment, and wants to help advance sophisticated pharmacy transaction capabilities.

This is a hands-on product leadership role with meaningful ownership of core adjudication and transaction capabilities. You'll work closely with engineering and business teams to set product direction, solve complex technical and operational challenges, and deliver reliable, scalable technology that supports our pharmacy solutions. You'll need strong product judgment, a deep understanding of the claims lifecycle, and an appreciation for how product decisions affect members, pharmacies, clients, and financial outcomes.

We're looking for more than familiarity with claims processing. You'll need direct experience leading the development, enhancement, and delivery of adjudication platform capabilities, along with a strong understanding of the operational and financial implications of how claims are processed. Experience operating these systems is a plus.

You'll report to our Chief Product Officer and work closely with Product, Engineering, Operations, Clinical, Finance, and other teams.

What You'll Do

• Own the product direction. Lead the roadmap and priorities for core pharmacy adjudication and transaction capabilities, balancing business needs, operational requirements, and technical considerations.
• Advance adjudication capabilities. Define requirements across the pharmacy claims lifecycle, including eligibility, benefit configuration, pricing, clinical edits, member cost share, accumulators, and financial reconciliation.
• Partner closely with engineering. Shape platform capabilities, interfaces, and integrations to deliver reliable, scalable solutions that work across Prescryptive's products.
• Lead through complexity. Bring together technical and business teams, resolve competing requirements, make sound tradeoffs, and drive clear decisions and accountability.
• Drive delivery and readiness. Work across teams to move capabilities from requirements through production, ensuring transaction accuracy, thorough validation, and operational readiness.
• Measure and improve results. Use processing performance, transaction data, and operational metrics to identify opportunities, guide improvements, and connect product decisions to business and customer outcomes.

What You'll Bring (Required)

• Direct adjudication technology product ownership. At least 8 years in product management or related platform roles, including at least 3 years directly accountable for the product requirements, priorities, and production delivery of a pharmacy claims adjudication engine or substantial core adjudication platform capabilities.
• Deep PBM and pharmacy claims expertise. Strong working knowledge of pharmacy claims adjudication, PBM operations, and the full transaction lifecycle, including eligibility, benefit configuration, pricing, member cost share, accumulators, and downstream financial outcomes. Demonstrated understanding of how adjudication platforms perform in production and the operational implications of product decisions.
• Knowledge of pharmacy transaction standards and processing. Hands-on understanding of NCPDP transactions, including rejects, reversals, resubmissions, coordination of benefits, and the complexities of claims processing at scale.
• Strong technical and product judgment. Demonstrated ability to translate complex business and processing rules into clear product requirements, acceptance criteria, and testing scenarios, with technical fluency in APIs, data models, configurable rules, and high-volume transaction systems.
• Proven cross-functional leadership. Experience leading complex product initiatives from requirements through production, resolving competing priorities, making sound tradeoffs, and driving results across engineering, business, and operational teams.
• Analytical strength and clear communication. Ability to use transaction data and operational metrics to diagnose problems and improve outcomes, communicate effectively with technical and executive audiences, and incorporate privacy, security, compliance, and auditability requirements into product decisions.

Ideally You'll Also Have (Preferred)

• Experience with direct responsibility for operating or supporting production pharmacy adjudication platforms, including troubleshooting complex claims processing issues and maintaining operational performance.
• Experience delivering major adjudication platform enhancements, integrations, and phased releases while maintaining continuity of production operations.
• Experience across both commercial and government pharmacy benefits, including configurable benefit and pricing rules.
• Experience with pharmacy payment processes, financial reconciliation, and settlement workflows.
• Education. Bachelor's degree in business, healthcare, engineering, computer science, or a related field, or equivalent relevant experience.

Benefits

• The opportunity to grow alongside an early-stage company working to change a large, complex, and highly consequential industry
• 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

Prescryptive is committed to fair pay practices. The projected annual salary for this position is $177,500 to $222,500. When preparing an offer, we consider the candidate's resume, experience, interview feedback, internal equity, and location.

Equal Employment Opportunity

Prescryptive is an Equal Opportunity Employer. Prescryptive does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law. All employment is decided on the basis of qualifications, merit, and business need.