Principal Technical Product Manager – PBM Benefit Data Integrations

Prescryptive Health is a healthcare technology company delivering solutions that empower consumers. The Principal Technical Product Manager will serve as the senior delivery owner for complex PBM benefit data integration initiatives, managing end-to-end program execution and ensuring data quality and operational readiness.

Responsibilities:

• Own end-to-end delivery of PBM benefit data integration initiatives impacting claims, eligibility, accumulators, and related platforms
• Identify, assess, and manage program risks, including coordinating root-cause remediation efforts in partnership with engineering and operations teams
• Drive cross-functional alignment on technical and operational requirements to ensure scalable, compliant integration design
• Design and validate scalable solution architectures supporting claim processing, eligibility, accumulators, and reporting
• Partner cross-functionally with business stakeholders, internal development teams, and external vendors to improve systems, workflows, and data accuracy
• Own delivery timelines, milestone tracking, and executive-level reporting for benefit data integration initiatives
• Coordinate implementation readiness including rollback planning, validation artifacts, and post-deployment support models
• Ensure adherence to security standards, data governance practices, and operational policies
• Drive implementation validation including testing, rollback planning, data migration, and post-install support
• Integrate and conform complex data from multiple sources including claims, provider, member, encounter, eligibility, and accumulator files to ensure integrity and operational continuity
• Conduct advanced data profiling and mapping to ensure alignment between source and target systems
• Monitor and resolve daily member eligibility and accumulator discrepancies arising from file imports and monthly reconciliations
• Develop and execute SQL queries to support investigation, validation, regression testing, and operational research
• Format and prepare data for one-off file loads, testing, and special projects (e.g., MPAs, formularies)
• Drive cross-functional remediation strategies for complex production issues impacting benefit data integrity. Anticipate potential system or data failures and proactively implement preventative solutions
• Present findings, business impact assessments, and recommended remediation plans to leadership and stakeholders
• Gather, validate, and document business and technical requirements
• Analyze requirements for completeness, feasibility, and standards alignment
• Assess functional and non-functional requirements and design scalable technical solutions
• Identify architectural impacts and recommend system enhancements
• Deliver implementation guidance including rollback strategies, support plans, and validation artifacts
• Plan and coordinate integration testing and User Acceptance Testing (UAT)
• Perform claim testing using PBM platforms and tools such as Postman
• Conduct regression testing and validate system enhancements prior to deployment
• Support ETL processes, file transfers (SFTP/PGP), and job scheduler automation
• Assist in ensuring SLA compliance
• Maintain system documentation and operational procedures
• Communicate technical findings and data-driven insights to both technical and non-technical stakeholders
• Collaborate with internal development teams and external vendor/client development teams
• Present recommendations to leadership and incorporate stakeholder feedback
• Adhere to security management practices and promote established data governance standards
• Comply with all organizational policies and regulatory requirements
• Perform other duties as assigned

Requirements:

• Bachelor's degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or related quantitative field (required)
• 10+ years of progressive experience in healthcare analytics, PBM operations, data integration, or business systems analysis (required)
• Experience within a PBM or healthcare claims processing environment (required)
• Deep expertise in PBM benefit configuration, adjudication logic, eligibility, and accumulator integrations
• Advanced proficiency in SQL (advanced querying and data investigation)
• Experience managing delivery timelines, risks, dependencies, and remediation coordination
• Working knowledge of ANSI/NCPDP Telecommunication Standard
• Working understanding of PBM or TPA claim processing
• Experience with data ETL processes and file delivery mechanisms (SFTP, PGP)
• Experience with job scheduling automation and alerting tools
• Microsoft Azure cloud experience, including blob storage
• Integration testing and UAT coordination experience
• Familiarity with C#, Java, JavaScript, Python, or R preferred
• Experience with RxLogic or similar pharmacy benefits and claims adjudication platform
• Experience supporting eligibility and accumulator reconciliation processes
• Experience designing scalable data architecture
• Experience working in cloud-based healthcare data environments