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Role Description

The Product and Engineering team at SmithRx is developing the next-generation modern pharmacy benefits management (PBM) platform that will change how companies administer and manage pharmacy benefits. Our unified technology platform provides real-time actionable insights that drive cost savings, power clinical services, and result in a brilliant customer experience.

As a Senior Product Manager, you will own the vision, strategy, and execution of our core claims adjudication engine. This role is the backbone of our mission to disrupt the PBM industry, ensuring that every prescription claim is processed with precision and accuracy. You will leverage your deep expertise in NCPDP standards, real-time transaction processing, and pharmacy billing workflows to build and scale our tech-first platform that outpaces legacy PBM systems.

As the product leader for claim routing and pricing logic, you will bridge the gap between complex clinical rules and high-performance engineering, guiding cross-functional teams to deliver a seamless, transparent experience for pharmacies, clients, and members.

What you will do:

• Product Strategy & Vision: Define and drive the multi-year product roadmap for the SmithRx claims adjudication platform, identifying opportunities to enhance processing speed, automation, and transparency while maintaining a highly flexible, cloud-native architecture.
• Adjudication Logic & Standards: Serve as an internal product Subject Matter Expert (SME) on NCPDP Telecommunication Standards (D.0 and beyond). Translate complex benefit designs, coordination of benefits (COB), and real-time pricing models into scalable, automated logic.
• End-to-End Product Lifecycle: Lead the full product lifecycle for adjudication features—from initial requirement gathering through engineering sprints and quality assurance—ensuring that new logic deployments do not disrupt high-volume, real-time transaction flows.
• Cross-Functional Leadership: Partner closely with Engineering, Data Science, Implementation and Operations teams to write detailed technical user stories, manage the adjudication platform backlog, and ensure the engine scales to support complex clinical rules and custom client configurations.
• System Integrity & Performance: Create, monitor and optimize key performance indicators (KPIs) related to claim success rates, latency, and financial accuracy. Develop robust testing frameworks to ensure that pricing logic and eligibility checks are 100% accurate at the point of sale.
• Stakeholder & Vendor Engagement: Collaborate with internal Operations and Clinical teams to streamline manual overrides, exception handling and other processes. Support engagement with external partners, such as switch vendors and PSAOs, to resolve routing issues and improve the pharmacy provider experience.
• Regulatory & Market Alignment: Ensure the adjudication engine is built to support evolving industry requirements; prior experience working with EGWP guidelines, Medicare Part D compliance, or OIG/CMS reporting standards is a significant plus to ensure our platform remains competitive.

Qualifications

• 5+ years of progressive experience in Product Management or a related technical domain, with a minimum of 3+ years dedicated to claims adjudication, pharmacy switch technology, or PBM core platforms.
• Deep technical knowledge of NCPDP Telecommunication Standards (specifically Version D.0) and the transactional workflows between pharmacies, switches, and PBMs.
• Expertise in complex benefit strings, including real-time pricing logic, Coordination of Benefits (COB), and eligibility verification.
• Proven ability to lead cross-functional collaboration across Engineering, Data Science, and Operations to deliver high-concurrency, low-latency technical solutions.
• Strong analytical skills with experience leveraging AI tools and data modeling to improve system efficiency, audit claim accuracy, and automate exception handling.
• High-stakes delivery: Ability to prioritize and execute in a fast-paced environment where system uptime and financial accuracy are mission-critical.
• Excellent communication skills, with the unique ability to translate claim logic into clear business impact for executive leadership and clients.
• Significant plus: experience incorporating EGWP guidelines into adjudication logic; a strong understanding of CMS-mandated benefit phases and their technical implementation.

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance.
• Flexible Spending Benefits.
• 401(k) Retirement Savings Program.
• Short-term and long-term disability.
• Discretionary Paid Time Off.
• Paid Company Holidays.
• Wellness Benefits.
• Commuter Benefits.
• Paid Parental Leave benefits.
• Employee Assistance Program (EAP).
• Well-stocked kitchen in office locations.
• Professional development and training opportunities.