Senior Product Manager - Adjudication

SmithRx is a rapidly growing, venture-backed Health-Tech company dedicated to transforming the Pharmacy Benefit Management sector. As a Senior Product Manager, you will own the vision and execution of the claims adjudication engine, ensuring precise processing of prescription claims and collaborating with cross-functional teams to enhance the platform's capabilities.

Responsibilities:

• 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
• 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
• 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
• 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
• 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
• 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
• 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

Requirements:

• 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
• Experience incorporating EGWP guidelines into adjudication logic
• Strong understanding of CMS-mandated benefit phases and their technical implementation