Sr. Product Manager | Pharmacy Payment Integrity

The Rawlings Group; La Grange (KY); On-site; USD 90,000 - 150,000; Full time

Benefits offered by this job

Top Medical/Dental/Vision offerings

Unlimited PTO

Tuition reimbursement

401(k) with company match

Flexible work environment

Job summary

The Rawlings Group is looking for a Product Manager, Pharmacy Payment Integrity, to drive AI-first automation for pharmacy payment workflows. The ideal candidate will manage the product roadmap, focusing on AI agents, voice automation, and customer analytics.

Applicants should have a Computer Science degree and at least 5 years of experience in both Product Management and Software Engineering. Remote work is supported, along with a competitive salary and extensive benefits.

Qualifications

• 5+ years of experience as both Product Manager and Software Engineer.
• Hands-on coding background is required.
• Experience with AI-powered automation and customer-facing analytics.

Responsibilities

• Design AI agents for automation in COB investigations and claims management.
• Integrate voice AI for verification workflows.
• Build automation for billing and denial recovery processes.

Skills

Product Management

Software Engineering

Automation

Analytics

API Integrations

Education

Computer Science degree (BS/MS required)

Tools

AI architectures

BI platforms

Job description

Machinify is a leading healthcare intelligence company with expertise across the payment continuum, delivering unmatched value, transparency, and efficiency to health plan clients across the country. Deployed by over 85 health plans, including many of the top 20, and representing more than 270 million lives, Machinify brings together a fully configurable and content‑rich, AI‑powered platform along with best‑in‑class expertise. We’re constantly reimagining what’s possible in our industry, creating disruptively simple, powerfully clear ways to maximize financial outcomes and drive down healthcare costs.

Product Manager, Pharmacy Payment Integrity

Machinify is seeking a Product Manager to transform pharmacy payment integrity from manual workflows to AI‑first automation. Own the product roadmap for AI agents, voice AI and IVR automation, intelligent data acquisition, automated payment/recovery workflows, and customer‑facing analytics.

What you’ll do

• Agentic workflow automation: Design and ship AI agents that automate COB investigations, primacy determination, validation, claims tagging, and recovery handoff across Medicare, Medicaid, and commercial flows.
• Voice AI and conversational data acquisition: Replace legacy IVR/phone‑based verification with AI‑powered conversational workflows; integrate third‑party insurance discovery APIs and PBM portal automation.
• Payment and recovery automation: Build end‑to‑end automation for bulk billing, auto‑invoicing, denial recovery, and recovery submission workflows.
• Customer‑facing analytics: Redesign the customer portal with real‑time dashboards, SLA transparency, recovery pipeline visibility, and self‑service reporting that crystallizes customer ROI.
• AI agent capabilities: Define agent behavior, decision logic, human‑in‑the‑loop handoffs, quality guardrails, and pilot‑to‑scale deployment plans.
• Operational transformation: Partner with operations teams to identify high‑volume, low‑complexity workflows for automation; translate domain expertise into automated logic.

Requirements

• Computer Science degree (BS/MS required)
• 5+ years of combined prior experience as both Product Manager AND Software Engineer (hands‑on coding background required)
• Technical understanding of agentic AI architectures, voice interfaces, API integrations, data pipelines, and BI platforms
• Track record transforming manual processes into automation‑first products with measurable ROI
• Experience building customer‑facing analytics for external clients
• Strong collaboration with operations and domain experts
• Management consulting experience and healthcare domain knowledge are a strong plus

What We Offer

• Work from anywhere in the US – Machinify is digital‑first
• Top Medical/Dental/Vision offerings
• FSA/HSA
• Tuition reimbursement
• Competitive salary, 401(k) with company match
• Unlimited PTO
• Additional health and wellness benefits and perks
• Flexible and trusting environment where you’ll feel empowered to do your best work

The salary for this position is based on an array of factors unique to each candidate: such as years and depth of experience, set skills, certifications, etc. We are hiring for different levels, and our Recruiting team will let you know if you qualify for a different role/range. Salary is one component of the total compensation package, which includes meaningful equity, excellent healthcare, flexible time off, and other benefits and perks.

Equal Employment Opportunity at Machinify We are committed to equal employment opportunity regardless of race, color, ancestry, religion, sex, national origin, sexual orientation, age, citizenship, marital status, disability, gender, gender identity or expression, or veteran status. We are proud to be an equal opportunity workplace. Machinify is an employment at will employer. We participate in E-Verify as required by applicable law. In accordance with applicable state laws, we do not inquire about salary history during the recruitment process. If you require a reasonable accommodation to complete any part of the application or recruitment process, please let our recruiters know. See our Candidate Privacy Notice at: https://www.machinify.com/candidate-privacy-notice/.