Director Product Pharmacy Claims Platform

Prescryptive Health, Inc. • Washington, NV

22d • $177,500 - $222,500

About The Position

Prescryptive is seeking a Director, Product (Pharmacy Claims Platform) to lead product direction for pharmacy claims adjudication and transaction capabilities. This hands-on product leadership role owns core adjudication and transaction capabilities and works closely with engineering and business teams to set direction, address technical and operational challenges, and deliver reliable, scalable technology supporting Prescryptive’s pharmacy solutions. The role requires strong product judgment, deep knowledge of the claims lifecycle, and awareness of how product decisions affect members, pharmacies, clients, and financial outcomes.

The director leads the roadmap and priorities for core pharmacy adjudication capabilities, defines requirements throughout the claims lifecycle, shapes platform capabilities and integrations, and leads cross-functional teams through delivery into production. The role also uses transaction data and operational metrics to identify improvements and connect product decisions to business and customer outcomes. The position reports to the Chief Product Officer and collaborates 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, including eligibility, benefit configuration, pricing, member cost share, accumulators, and downstream financial outcomes.
• Demonstrated understanding of adjudication platforms in production and the operational implications of product decisions.
• 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 clear 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, resolving competing priorities, making sound tradeoffs, and driving results across engineering, business, and operational teams.
• 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.

Nice To Haves

• Experience 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.
• Bachelor's degree in business, healthcare, engineering, computer science, or a related field, or equivalent relevant experience.

Responsibilities

• Lead the product roadmap and priorities for core pharmacy adjudication and transaction capabilities, balancing business needs, operational requirements, and technical considerations.
• 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 that deliver reliable, scalable solutions across Prescryptive products.
• Bring technical and business teams together, resolve competing requirements, make tradeoffs, and drive clear decisions and accountability.
• Lead capabilities from requirements through production, ensuring transaction accuracy, thorough validation, and operational readiness.
• Use processing performance, transaction data, and operational metrics to identify opportunities, guide improvements, and connect product decisions to business and customer outcomes.

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 consequential industry.

What This Job Offers

• Job Type: Full-time
• Career Level: Director
• Education Level: No Education Listed