Senior Product Manager, PBM Platform
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What you'll do
- Own the vision, roadmap, and delivery plan for claims adjudication, including how it scales with volume, new clients, and new lines of business
- Build deep expertise in how pharmacy claims adjudicate across eligibility, coverage rules, pricing, rejections, overrides, and coordination of benefits, and turn that into a structured, prioritized plan
- Define the long-term strategy for how the platform evolves to support operational scale, regulatory requirements, and new lines of business, including Medicare
- Write clear specs, user stories, and acceptance criteria that engineering and QA can execute against, and lead backlog refinement, sprint planning, and release coordination in an agile environment
- Partner day to day with the adjudication engineering team to sequence work, manage dependencies, and resolve ambiguity in claim behavior quickly
- Set the bar for correctness and own the testing and claim certification approach that proves the system is ready for production volume
- Own readiness and rollout planning, including validation against real claim volume, parallel testing, and phased release
- Coordinate go-live readiness across operations, clinical, client success, and compliance so changes land without disruption to members or clients
- Partner with PBM operations, clinical, legal, and client success teams to ensure the platform meets workflow and regulatory requirements
- Manage the drug data, formulary, and prior authorization dependencies adjudication relies on, treating the internal teams who own them as first-class partners
- Define and track KPIs for claim accuracy, system performance, and reliability
- Act as the primary product point of contact for adjudication across the organization and with external partners
What they're looking for
- Bachelor's degree required; 5 or more years of product management experience, preferably in healthcare or enterprise technology
- Experience with complex, rules-driven transaction processing systems such as claims adjudication, payments, or benefit administration, including responsibility for correctness and testing
- Experience leading a platform migration or major system transition from requirements through go-live
- Proven ability to lead cross-functional initiatives involving product, engineering, legal, and operations stakeholders
- Ability to work independently and drive execution with minimal direction
- Strong communicator who collaborates well across technical and non-technical teams
- Detail oriented and process focused, and comfortable in a domain where correctness is measured claim by claim
- Comfortable working across complex, data-heavy systems
- Curious and adaptable, willing to dig into unfamiliar and highly technical territory and find answers
Nice to have
- Experience working in or with PBMs, pharmacy claims, or pharmacy operations is a plus
- Familiarity with systems that support regulated healthcare markets, including Medicare, is a plus
- Knowledge of pharmacy-related data standards such as NCPDP or Medi-Span is a plus
- Exposure to APIs, system integrations, or healthcare data platforms is a plus
- An advanced degree in a relevant field (MBA, MPH, or a technical degree) is a plus
Summarised by NextRaise from the employer’s description, which follows in full below.
Full description from employer
ABOUT THE ROLE:
Rightway is looking for a Senior Product Manager to own claims adjudication, the system at the center of Rightway’s PBM. Adjudication covers the full lifecycle of a pharmacy claim: eligibility, coverage, pricing, rejections, overrides, and coordination of benefits. It is one of the most complex and consequential product areas at Rightway, and this role owns its strategy, roadmap, and delivery.
You will develop deep expertise in how pharmacy claims adjudicate today and use that to define where the platform goes next — working through real claim behavior alongside engineering, writing requirements precise enough to build against, setting the bar for correctness, and owning the validation approach that proves the system is ready for production volume. The role reports to the Director, Product Management, and operates with a high degree of independence. It requires someone who can take full ownership of a major product initiative and work cross-functionally across product, engineering, operations, clinical, and compliance.
WHAT YOU’LL DO:
- Own the vision, roadmap, and delivery plan for claims adjudication, including how it scales with volume, new clients, and new lines of business
- Build deep expertise in how pharmacy claims adjudicate across eligibility, coverage rules, pricing, rejections, overrides, and coordination of benefits, and turn that into a structured, prioritized plan
- Define the long-term strategy for how the platform evolves to support operational scale, regulatory requirements, and new lines of business, including Medicare
- Write clear specs, user stories, and acceptance criteria that engineering and QA can execute against, and lead backlog refinement, sprint planning, and release coordination in an agile environment
- Partner day to day with the adjudication engineering team to sequence work, manage dependencies, and resolve ambiguity in claim behavior quickly
- Set the bar for correctness and own the testing and claim certification approach that proves the system is ready for production volume
- Own readiness and rollout planning, including validation against real claim volume, parallel testing, and phased release
- Coordinate go-live readiness across operations, clinical, client success, and compliance so changes land without disruption to members or clients
- Partner with PBM operations, clinical, legal, and client success teams to ensure the platform meets workflow and regulatory requirements
- Manage the drug data, formulary, and prior authorization dependencies adjudication relies on, treating the internal teams who own them as first-class partners
- Define and track KPIs for claim accuracy, system performance, and reliability
- Act as the primary product point of contact for adjudication across the organization and with external partners
WHO YOU ARE:
- Bachelor's degree required; 5 or more years of product management experience, preferably in healthcare or enterprise technology
- Experience with complex, rules-driven transaction processing systems such as claims adjudication, payments, or benefit administration, including responsibility for correctness and testing
- Experience leading a platform migration or major system transition from requirements through go-live
- Proven ability to lead cross-functional initiatives involving product, engineering, legal, and operations stakeholders
- Ability to work independently and drive execution with minimal direction
- Strong communicator who collaborates well across technical and non-technical teams
- Detail oriented and process focused, and comfortable in a domain where correctness is measured claim by claim
- Comfortable working across complex, data-heavy systems
- Curious and adaptable, willing to dig into unfamiliar and highly technical territory and find answers
- Experience working in or with PBMs, pharmacy claims, or pharmacy operations is a plus
- Familiarity with systems that support regulated healthcare markets, including Medicare, is a plus
- Knowledge of pharmacy-related data standards such as NCPDP or Medi-Span is a plus
- Exposure to APIs, system integrations, or healthcare data platforms is a plus
- An advanced degree in a relevant field (MBA, MPH, or a technical degree) is a plus
COMPENSATION: $150,000 - $195,000 annually, in addition to bonus and equity
Compensation offered will be determined by geographic location, experience, and qualifications.
CYBERSECURITY AWARENESS NOTICE
In response to ongoing and industry-wide fraudulent recruitment activities (i.e., job scams), Rightway wants to inform potential candidates that we will only contact them from the @rightwayhealthcare.com email domain. We will never ask for bank details or deposits of any kind as a condition of employment.
ABOUT RIGHTWAY:
Rightway is on a mission to harmonize healthcare for everyone, everywhere. Our products guide patients to the best care and medications by inserting clinicians and pharmacists into a patient’s care journey through a modern, mobile app. Rightway is a front door to healthcare, giving patients the tools they need along with on-demand access to Rightway health guides, human experts that answer their questions and manage the frustrating parts of healthcare for them.
Since its founding in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global. We’re headquartered in New York City, with satellite offices in Denver and Dallas. Our clients rely on us to transform the healthcare experience, improve outcomes for their teams, and decrease their healthcare costs.
HOW WE LIVE OUR VALUES TO OUR TEAMMATES:
We’re seeking those with passion for healthcare and relentless devotion to our goal. We need team members that embody our core values:
1) We are human, first
Our humanity binds us together. We bring the same empathetic approach to every individual we engage with, whether it be our members, our clients, or each other. We are all worthy of respect and understanding and we engage in our interactions with care and intention. We honor our stories. We listen to—and hear—each other, we celebrate our differences and similarities, we are present for each other, and we strive for mutual understanding.
2) We redefine what is possible
We always look beyond the obstacles in front of us to imagine new solutions. We approach our work with inspiration from other industries, other leaders, and other challenges. We use ingenuity and resourcefulness when faced with tough problems.
3) We debate then commit
We believe that a spirit of open discourse is part of a healthy culture. We understand and appreciate different perspectives and we challenge our assumptions. When working toward a decision or a new solution, we actively listen to one another, approach it with a “yes, and” mentality, and assume positive intent. Once a decision is made, we align and champion it as one team.
4) We cultivate grit
Changing healthcare doesn’t happen overnight. We reflect and learn from challenges and approach the future with a determination to strive for better. In the face of daunting situations, we value persistence. We embrace failure as a stepping stone to future success. On this journey, we seek to act with guts, resilience, initiative, and tenacity.
5) We seek to delight
Healthcare is complicated and personal. We work tirelessly to meet the goals of our clients while also delivering the best experience to our members. We recognize that no matter the role or team, we each play a crucial part in our members’ care and take that responsibility seriously. When faced with an obstacle, we are kind, respectful, and solution-oriented in our approach. We hold ourselves accountable to our clients and our members’ success.
Rightway is proud to be an Equal Opportunity Employer that believes in the strength of diverse thought, beliefs, backgrounds, and education. We foster an inclusive culture where differences are celebrated to drive the best business decisions possible. We do not discriminate on any basis protected by applicable law. All employment decisions are based on merit, qualifications, need, and performance.
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