Prescryptive Health is hiring a Principal Technical Program Manager (TPM) – PBM Benefit Data Integrations. In this senior delivery role, you will be accountable for the end-to-end execution of complex PBM benefit system and adjudication data initiatives, integrating and conforming data across claims processing, eligibility, accumulators, and interconnected healthcare platforms.
What You'll Do
- Own end-to-end delivery of PBM benefit data integration initiatives impacting claims, eligibility, accumulators, and related platforms.
- Identify, assess, and manage program risks, coordinating root-cause remediation with engineering and operations teams.
- Drive cross-functional alignment on technical and operational requirements to ensure scalable, compliant integration design.
- Design and validate scalable solution architectures supporting claim processing, eligibility, accumulators, and reporting.
- Partner cross-functionally with business stakeholders, internal development teams, and external vendors to improve systems, workflows, and data accuracy.
- Own delivery timelines, milestone tracking, and executive-level reporting for benefit data integration initiatives.
- Coordinate implementation readiness including rollback planning, validation artifacts, and post-deployment support models.
- Integrate and conform complex data from multiple sources including claims, provider, member, encounter, eligibility, and accumulator files.
- Conduct advanced data profiling and mapping to ensure alignment between source and target systems.
- Monitor and resolve daily member eligibility and accumulator discrepancies from file imports and monthly reconciliations.
- Develop and execute SQL queries to support investigation, validation, regression testing, and operational research.
- Present findings, business impact assessments, and recommended remediation plans to leadership and stakeholders.
- Gather, validate, and document business and technical requirements, analyzing them for completeness and feasibility.
- Plan and coordinate integration testing and User Acceptance Testing (UAT).
- Support ETL processes, file transfers (SFTP/PGP), and job scheduler automation.
- Communicate technical findings and data-driven insights to both technical and non-technical stakeholders.
- Adhere to security standards, data governance practices, and operational policies.
What We're Looking For
- Bachelor’s degree in Statistics, Mathematics, Engineering, Computer Science, Business Analytics, or a related quantitative field.
- 10+ years of progressive experience in healthcare analytics, PBM operations, data integration, or business systems analysis.
- Experience within a PBM or healthcare claims processing environment.
- Deep expertise in PBM benefit configuration, adjudication logic, eligibility, and accumulator integrations.
- Advanced proficiency in SQL for advanced querying and data investigation.
- Experience managing delivery timelines, risks, dependencies, and remediation coordination.
- Working knowledge of ANSI/NCPDP Telecommunication Standard.
- Working understanding of PBM or TPA claim processing.
- Experience with data ETL processes and file delivery mechanisms (SFTP, PGP).
- Experience with job scheduling automation and alerting tools.
- Microsoft Azure cloud experience, including blob storage.
- Integration testing and UAT coordination experience.
Nice to Have
- Familiarity with C#, Java, JavaScript, Python, or R.
- Experience with RxLogic or similar pharmacy benefits and claims adjudication platforms.
- Experience supporting eligibility and accumulator reconciliation processes.
- Experience designing scalable data architecture.
- Experience working in cloud-based healthcare data environments.
Technical Stack
- SQL
- Microsoft Azure
- SFTP, PGP
- C#, Java, JavaScript, Python, R
Benefits & Compensation
- Compensation range: $148k to $205k.
- Flexible time off, including 12 paid holidays.
- 401k match plus 100% employer paid medical, dental, and vision.
- Company contribution to Health Savings Account.
- Stock options.
The opportunity to grow alongside an early-stage company shaking up a big, old-fashioned industry.
Prescryptive is an Equal Opportunity Employer. Prescryptive does not discriminate on the basis of race, religion, color, sex, gender identity, sexual orientation, age, non-disqualifying physical or mental disability, national origin, veteran status or any other basis covered by appropriate law.
