Senior Product Manager, PBM Platform
Core
Own the strategy, roadmap, and delivery of claims adjudication, the central system for processing pharmacy claims including eligibility, coverage, pricing, and coordination of benefits.
Role type
Senior Product Manager (Healthcare PBM Platform)
Builds
Claims adjudication platform supporting eligibility, coverage rules, pricing, rejections, and coordination of benefits
Domain
Healthcare / Pharmacy Benefit Management (PBM)
Deliverable
production ML models | product features
Required skills
Product strategy, roadmap planning, requirements specification, backlog management, cross-functional leadership, validation planning, KPI definition, stakeholder management
Preferred skills
PBM operations experience, Medicare familiarity, NCPDP/Medi-Span data standards knowledge, API/system integration exposure, advanced degree (MBA/MPH)
Technologies
NCPDP, Medi-Span, Medicare systems
Responsibilities
Define long-term strategy for platform evolution and scale, write clear specs and user stories for engineering, partner with engineering to sequence work and resolve claim behavior ambiguity, own testing and claim certification approaches, coordinate go-live readiness across operations and compliance, manage drug data and formulary dependencies, define and track KPIs for claim accuracy and system performance
Seniority
Senior, hands-on IC