Director, Product Pharmacy Claims Platform

🔥 17 hours ago

🌐 United States, Australia – Remote

🇺🇸 United States – Remote 🇦🇺 Australia – Remote

🐻 Alaska, Arizona, +43 more states – Remote

🐻 Alaska – Remote 🌵 Arizona – Remote 🏄 California – Remote ⛰️ Colorado – Remote 🦌 Connecticut – Remote 🐊 Florida – Remote 🌺 Hawaii – Remote 🥔 Idaho – Remote 🌽 Illinois – Remote 🌾 Iowa – Remote 🌪️ Kansas – Remote 🐎 Kentucky – Remote ⚜️ Louisiana – Remote 🦞 Maine – Remote 🦬 Montana – Remote 🌾 Nebraska – Remote 🎰 Nevada – Remote 🗻 New Hampshire – Remote 🏖️ New Jersey – Remote 🌶️ New Mexico – Remote 🗽 New York – Remote 🌲 North Carolina – Remote 🌾 North Dakota – Remote 🏈 Ohio – Remote 🌪️ Oklahoma – Remote 🌲 Oregon – Remote 🦀 Maryland – Remote 🍂 Massachusetts – Remote 🚗 Michigan – Remote ❄️ Minnesota – Remote 🎸 Mississippi – Remote 🏰 Missouri – Remote 🔔 Pennsylvania – Remote ⚓ Rhode Island – Remote 🌴 South Carolina – Remote 🗿 South Dakota – Remote 🎸 Tennessee – Remote 🤠 Texas – Remote ⛷️ Utah – Remote 🍁 Vermont – Remote ⚔️ Virginia – Remote ☕ Washington – Remote ⛰️ West Virginia – Remote 🧀 Wisconsin – Remote 🦬 Wyoming – Remote

💵 $177.5k - $222.5k / year

⏰ Full Time

🔴 Lead

💊 Pharmacist

👻 Ghost score 0%

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Prescryptive Health, Inc.

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2017

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Prescryptive Health, Inc. is a healthcare technology company that operates the myPrescryptive platform to help patients, pharmacies, employers, health systems, and pharma manufacturers manage and optimize prescription medications. Its SaaS platform provides real-time patient alerts, digital prescription management (no app required), EHR integration, and AI-driven pricing tools to improve medication adherence, transparency, affordability, and pharmacy profitability. Prescryptive offers employer-facing benefit solutions (emPBM), pharmacy pricing optimization, and consumer-facing tools to compare prices and track medication spend, with security certifications such as HITRUST.

📋 Description

• Own product direction, roadmap, and priorities for core pharmacy adjudication and transaction capabilities • Define requirements across the pharmacy claims lifecycle, including eligibility, benefit configuration, pricing, clinical edits, member cost share, accumulators, and financial reconciliation • Partner with engineering to shape platform capabilities, interfaces, and integrations • Bring together technical and business teams, resolve competing requirements, make tradeoffs, and drive decisions and accountability • Move capabilities from requirements through production while ensuring transaction accuracy, validation, and operational readiness • Use processing performance, transaction data, and operational metrics to identify opportunities and guide improvements • Connect product decisions to business and customer outcomes • Report to the Chief Product Officer • Collaborate with Product, Engineering, Operations, Clinical, Finance, and other teams

🎯 Requirements

• At least 8 years in product management or related platform roles • At least 3 years directly accountable for product requirements, priorities, and production delivery of a pharmacy claims adjudication engine or substantial core adjudication platform capabilities • Strong working knowledge of pharmacy claims adjudication, PBM operations, and the full transaction lifecycle • Hands-on understanding of NCPDP transactions, including rejects, reversals, resubmissions, coordination of benefits, and claims processing at scale • Ability to translate complex business and processing rules into product requirements, acceptance criteria, and testing scenarios • Technical fluency in APIs, data models, configurable rules, and high-volume transaction systems • Experience leading complex product initiatives from requirements through production • Ability to use transaction data and operational metrics to diagnose problems and improve outcomes • Ability to communicate effectively with technical and executive audiences • Ability to incorporate privacy, security, compliance, and auditability requirements into product decisions • Experience operating or supporting production pharmacy adjudication platforms • Experience delivering adjudication platform enhancements, integrations, and phased releases • Experience across commercial and government pharmacy benefits • Experience with pharmacy payment processes, financial reconciliation, and settlement workflows • Bachelor's degree in business, healthcare, engineering, computer science, or a related field, or equivalent relevant experience

🏖️ Benefits

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