Senior Product Manager, PBM Platform

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 a