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 sup