Product Manager - Pharmacy Benefit Management

Required Skills & Experience

• 6+ years of Product Management experience, including ownership of product strategy and roadmap development with demonstrated user adoption and business impact • Healthcare industry experience with strong knowledge of benefits administration, including plan structures, pharmacy benefit management (PBM), claims submission, and claims processing • Proven experience leading Machine Learning initiatives that delivered measurable business value • Experience working within Agile/Scrum environments; Scrum Master certification or prior Scrum Master experience is highly preferred • Cloud platform experience, preferably Google Cloud Platform (GCP) • Exceptional communication and stakeholder management skills • Ability to work core business hours of 9:00 AM–5:00 PM EST • Willingness to travel occasionally (approximately 10%)

Nice to Have Skills & Experience

• Direct experience supporting PBM-related products or applications • Experience leading AI initiatives within healthcare, including recommendation engines, intelligent agents, or orchestration solutions • Scrum Master certification • GCP experience

Job Description

we are seeking a Product Manager to join a leading healthcare organization within its Analytics division, supporting the Pharmacy Benefit Management (PBM) business. This individual will lead a high-priority initiative focused on modernizing and streamlining the benefit plan creation process through Machine Learning and advanced analytics. Today, onboarding new clients requires Subject Matter Experts and Value Implementation Managers to navigate a lengthy process involving multiple client discussions, plan configuration reviews, testing cycles, regulatory validation, and final approvals. This workflow is highly manual, time-consuming, and costly. The organization recently completed a successful Proof of Concept and is now launching a new initiative designed to accelerate plan creation by leveraging historical claims data. Using Machine Learning, the solution will analyze incoming claims and recommend the top 3–5 most relevant plan IDs, providing implementation teams with a strong starting point rather than building plans from scratch. The Product Manager will be responsible for defining and driving the product roadmap for this solution, partnering closely with business stakeholders, data scientists, engineers, and implementation teams. The ideal candidate will bring a strong blend of healthcare benefits expertise, product leadership, Agile delivery experience, and a proven track record of delivering value from Machine Learning-based products. Key responsibilities include: • Define and execute the product strategy and roadmap for the claim-to-plan recommendation platform • Partner with business and technical stakeholders to translate requirements into actionable product features • Prioritize product enhancements based on customer needs, business value, and technical feasibility • Drive Agile delivery ceremonies and collaborate closely with cross-functional teams • Measure product performance, adoption, and business outcomes • Serve as the liaison between business teams, data science teams, and engineering resources to ensure successful delivery and adoption of the solution