RxCLAIM Product Owner

Introduction:
We are seeking a highly experienced RxCLAIM Product Owner to lead the product vision, roadmap, and delivery for enterprise Pharmacy Benefit Management (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.

Responsibilities:
- 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

Requirements:
Required Skills:
- 10+ years of experience in RxCLAIM or any other Pharmacy Benefit Management (PBM) systems Product Ownership
Preferred Skills:
- Experience with other PBM systems (e.g., MedImpact, Argus, custom PBM platforms)
- Knowledge of CMS, HIPAA, Medicaid, Medicare regulations