Senior Product Manager - Adjudication

Company Overview

SmithRx is a rapidly growing, venture‑backed Health‑Tech company. Our mission is to disrupt the expensive and inefficient Pharmacy Benefit Management (PBM) sector by building a next‑generation drug acquisition platform driven by cutting‑edge technology, innovative cost‑saving tools, and best‑in‑class customer service. With hundreds of thousands of members onboarded since 2016, SmithRx has a solution that is resonating with clients all across the country.

Core Values

• Integrity: Our purpose guides our actions and gives us confidence in the path ahead. With unwavering honesty and dependability, we embrace the pressure of challenging the old and exemplify ethical leadership to create the new.
• Courage: We face continuous challenges with grit and resilience. We embrace the discomfort of the unknown by balancing autonomy with empathy, and ownership with vulnerability. We boldly challenge the status quo to keep moving forward—always.
• Together: The success of SmithRx reflects the strength of our partnerships and the commitment of our team. Our shared values bind us together and make us one. When one falls, we all fall; when one rises, we all rise.

Job Summary

The Product and Engineering team at SmithRx is developing the next‑generation modern pharmacy benefits management (PBM) platform that will change how companies administer and manage pharmacy benefits. As a Senior Product Manager, you will own the vision, strategy, and execution of our core claims adjudication engine. This role is the backbone of our mission to disrupt the PBM industry, ensuring that every prescription claim is processed with precision and accuracy. You will leverage your deep expertise in NCPDP standards, real‑time transaction processing, and pharmacy billing workflows to build and scale our tech‑first platform that outpaces legacy PBM systems.

Key Responsibilities

• Product Strategy & Vision: 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.
• Adjudication Logic & Standards: Serve as an internal product 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.
• End‑to‑End Product Lifecycle: Lead the full product lifecycle for adjudication features—from initial requirement gathering through engineering sprints and quality assurance—ensuring new logic deployments do not disrupt high‑volume, real‑time transaction flows.
• Cross‑Functional Leadership: 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.
• System Integrity & Performance: Create, monitor and optimize key performance indicators (KPIs) related to claim success rates, latency, and financial accuracy. Develop robust testing frameworks to ensure pricing logic and eligibility checks are 100% accurate at the point of sale.
• Stakeholder & Vendor Engagement: 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.
• Regulatory & Market Alignment: 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.

What You Will Bring

• 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.
• Significant plus: experience incorporating EGWP guidelines into adjudication logic; a strong understanding of CMS‑mandated benefit phases and their technical implementation.

Why This Role is Exciting

• Build the Engine of Innovation – Drive the next wave of PBM disruption by owning the core “brain” of our platform. You’ll build high‑performance logic that processes millions of transactions with precision and absolute financial integrity.
• High‑Impact Domain and Ownership – You aren’t just managing a feature; you are shaping the very foundation of how SmithRx scales.
• A Strategic Seat at the Table – As the primary SME for Claims Adjudication, you won’t just execute; you will define the architecture of our competitive advantage.
• Solve the “Hard” Problems – Partner with world‑class Engineers and Data Scientists to solve the industry’s most complex puzzles.
• Grow With Us – As SmithRx continues its rapid growth, so will your influence. You will have the opportunity to lead the expansion of our technical product suite and redefine what a modern adjudication platform looks like.

Benefits

• Highly competitive wellness benefits including Medical, Pharmacy, Dental, Vision, and Life Insurance and AD&D Insurance
• 401(k) Retirement Savings Program
• Short‑term and long‑term disability
• Discretionary Paid Time Off
• Paid Company Holidays
• Paid Parental Leave benefits
• Employee Assistance Program (EAP)
• Well‑stocked kitchen in office locations
• Professional development and training opportunities

Equal Employment Opportunity

As set forth in SmithRx’s Equal Employment Opportunity policy, we do not discriminate on the basis of any protected group status under any applicable law.