RxCLAIM Product Owner

Role: RxCLAIM Product Owner

Location: Remote 

Job Description

We are seeking a highly experienced RxCLAIM Product Owner to lead the product vision, roadmap, and delivery for enterprise PBM solutions. The ideal candidate will have deep hands-on expertise in RxCLAIM, strong exposure to other PBM platforms, and a proven ability to work with business, clinical, and technology stakeholders to deliver scalable, compliant, and high-performing pharmacy solutions.

This role requires strong domain knowledge, strategic thinking, and the ability to translate complex PBM requirements into actionable product backlogs while driving continuous value delivery. 

Qualifications

10+ years of experience in RxCLAIM or any other Pharmacy Benefit Management (PBM) systems

Product Ownership

Own and drive the product vision, roadmap, and backlog for RxCLAIM-based solutions

Align product strategy with PBM business goals, regulatory requirements, and client needs

Define and prioritize features, enhancements, and technical initiatives based on business value 

RxCLAIM & PBM Domain Accountability

Act as subject matter expert (SME) for RxCLAIM modules including:- Claims adjudication

Plan setup & benefit configuration

Pricing, accumulators, and edits

Prior authorization & DUR

Eligibility, formularies, and networks

Leverage experience with other PBM systems (e.g., MedImpact, Argus, custom PBM platforms) to drive best practices and comparative insights

Support integrations with downstream and upstream systems (eligibility, providers, pharmacies, rebate systems, data warehouses) 

Agile Delivery & Stakeholder Management

Serve as Product Owner in Agile/Scrum teams, owning user stories, acceptance criteria, and backlog grooming

Work closely with architects, developers, QA, and DevOps teams to ensure high-quality delivery

Collaborate with business stakeholders, clients, operations, and compliance teams

Participate in PI planning, sprint planning, demos, and retrospectives

Compliance & Quality

Ensure solutions comply with CMS, HIPAA, Medicaid/Medicare, and state-specific regulations

Partner with compliance and audit teams during regulatory changes and implementations

Drive data accuracy, performance, and scalability across PBM solutions

Continuous Improvement

Analyze production issues, client feedback, and operational metrics to identify improvement opportunities

Support modernization initiatives such as cloud migration, automation, and API enablement

Mentor junior product owners and business analysts in PBM and RxCLAIM best practices