Director Product Pharmacy Claims Platform

Prescryptive Health, Inc.; United States; On-site; USD 180,000 - 240,000; Full time

Job summary

Prescryptive Health, Inc. is seeking a Director of Product for the Pharmacy Claims Platform.

You will own the roadmap for adjudication and transaction capabilities, partnering with engineering and operations to deliver scalable, production-ready solutions that impact members, pharmacies, and clients. The role requires 8+ years in product management with hands-on leadership of pharmacy claims systems, strong PBM knowledge, and the ability to translate complex rules into clear requirements and

Qualifications

• 8+ years in product management or related platform roles with ≥3 years owning pharmacy claims adjudication product requirements and delivery.
• Deep knowledge of pharmacy claims adjudication, PBM operations, and transaction lifecycle including eligibility, pricing, and cost share.
• Hands-on understanding of NCPDP transactions, including rejects, reversals, resubmissions, coordination of benefits, and scale.
• Ability to translate complex business rules into product requirements, acceptance criteria, and testing scenarios with API fluency.
• Proven cross-functional leadership across engineering, business, and operations with clear decision making.

Responsibilities

• Own the product direction and lead the roadmap for core adjudication and transaction capabilities across Prescryptive's platform.
• Advance adjudication capabilities across the claims lifecycle including eligibility, benefit configuration, pricing, and financial reconciliation.
• Partner with engineering to shape platform capabilities, interfaces, and integrations for reliable, scalable solutions.
• Lead through complexity by aligning technical and business needs, resolving competing priorities, and driving accountability.
• Drive delivery and readiness across teams to move requirements into production with thorough validation.
• Measure impact using transaction data and operational metrics to improve outcomes and ensure privacy, security, and compliance.

Skills

Direct adjudication ownership

PBM & pharmacy claims expertise

NCPDP transaction knowledge

APIs & data models

Cross-functional leadership

Analytical communication

Tools

APIs

Data models

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.