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About the Role
Rightway is seeking a Senior Product Manager to lead the claims adjudication system, which manages the full lifecycle of pharmacy claims. This critical role involves defining strategy, roadmap, and delivery for one of Rightway's most complex product areas, requiring deep expertise in claim behavior and cross-functional collaboration.
Responsibilities
- Own the vision, roadmap, and delivery plan for claims adjudication, including scaling strategies.
- Develop deep expertise in pharmacy claims adjudication (eligibility, coverage, pricing, rejections, overrides, coordination of benefits) and create a prioritized plan.
- Define the long-term strategy for platform evolution to support operational scale, regulatory requirements, and new business lines, including Medicare.
- Write clear specifications, user stories, and acceptance criteria for engineering and QA.
- Lead backlog refinement, sprint planning, and release coordination in an agile environment.
- Partner with the adjudication engineering team to sequence work, manage dependencies, and resolve ambiguity.
- Set correctness standards and own the testing and claim certification approach for production readiness.
- 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 to ensure smooth transitions.
- Partner with PBM operations, clinical, legal, and client success teams to meet workflow and regulatory requirements.
- Manage dependencies related to drug data, formulary, and prior authorization with internal teams.
- Define and track KPIs for claim accuracy, system performance, and reliability.
- Serve as the primary product point of contact for adjudication internally and with external partners.
Requirements
- 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 (e.g., claims adjudication, payments, 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 communication skills and ability to collaborate across technical and non-technical teams.
- Detail-oriented and process-focused, comfortable in a domain where correctness is critical.
- Comfortable working across complex, data-heavy systems.
- Curious and adaptable, willing to explore technical territory and find answers.
- Experience working in or with PBMs, pharmacy claims, or pharmacy operations is a plus.
- Familiarity with systems supporting regulated healthcare markets, including Medicare, is a plus.
- Knowledge of pharmacy-related data standards (e.g., NCPDP, 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.
Skills
- Product Management
- Claims Adjudication
- Pharmacy Claims
- Healthcare Technology
- Enterprise Technology
- Rules-Driven Transaction Processing
- Platform Migration
- System Transition
- Cross-functional Leadership
- Agile Methodologies
- Backlog Refinement
- Sprint Planning
- Release Coordination
- API Integration
- Data Standards (NCPDP, Medi-Span)
- PBM Operations
- Medicare Systems
- KPI Definition and Tracking
- Communication
- Problem Solving
Location
- New York City
- Denver
- Dallas
Work Type
- Full-time
Experience Level
- Senior
Education Level
- Bachelor's degree
- Advanced degree (MBA, MPH, or technical degree) is a plus
Salary/Compensations
- $150,000 - $195,000 annually, in addition to bonus and equity
About the Company
- Rightway is on a mission to harmonize healthcare for everyone, everywhere.
- Their 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 acts as a front door to healthcare, providing tools and on-demand access to health guides.
- Founded in 2017, Rightway has raised over $200mm from investors including Khosla Ventures, Thrive Capital, and Tiger Global.
- Headquartered in New York City, with satellite offices in Denver and Dallas.
- Clients rely on Rightway to transform the healthcare experience, improve outcomes, and decrease healthcare costs.
Equal Opportunity
- Rightway is proud to be an Equal Opportunity Employer that believes in the strength of diverse thought, beliefs, backgrounds, and education.
- They foster an inclusive culture where differences are celebrated to drive the best business decisions possible.
- They do not discriminate on any basis protected by applicable law.
- All employment decisions are based on merit, qualifications, need, and performance.