Jobs at Rightway

Determines coverage for medical, dental, and vision procedures; investigates and resolves questionable claims, billing issues, and member inquiries. Reviews health plan provisions, gathers information from providers and other parties, communicates deductible and coinsurance activity, documents claim updates in a CRM, protects claimant information under HIPAA, and delivers timely customer service.

Own the vision, roadmap, delivery, and operational readiness of Rightway’s pharmacy claims adjudication platform. Lead requirements, backlog prioritization, testing, claim certification, migration, rollout, and KPI tracking while partnering with engineering, operations, clinical, legal, compliance, and client success teams. Ensure accurate, scalable, and regulatory-compliant claim processing across eligibility, coverage, pricing, rejections, overrides, coordination of benefits, and future Medicare lines of business.

Leads strategic partnership and channel growth for a healthcare benefits company. Responsibilities include identifying and developing aggregator relationships, managing commercial processes from discovery through contracting, negotiating pricing, overseeing partnership managers, collaborating on partner implementation and account growth, informing product strategy, and maintaining Salesforce pipeline visibility. The role requires extensive healthcare or benefits consulting experience, PBM expertise, strong commercial leadership, and travel as needed.

Lead architecture and delivery across Rails backends and React frontends, build Node.js and NestJS platform integrations, establish testing and code-quality standards, mentor engineers, review code, and improve reliability, performance, and developer experience. The role requires technical ownership across multiple backend technologies and leadership in AI-assisted development practices.

Leads the full lifecycle of pharmacy benefit management agreements, including drafting, negotiation, redlines, execution, amendments, renewals, and RFP responses. Structures financial, clinical, pricing, performance, and service terms while partnering with legal, finance, underwriting, clinical, operations, sales, and client success teams. Maintains contract templates and clause libraries, manages obligations and deadlines, and escalates legal, financial, and regulatory risks.

Own and grow a portfolio of client accounts for Rightway’s Care Navigation product. Build relationships with brokers, carriers and TPAs; drive renewals, upsells, success metrics, reporting, and quarterly business reviews; resolve escalations; collaborate cross-functionally; and deliver product training and operational improvements to maximize client satisfaction and retention.

Serve as primary client contact for a portfolio of accounts on the Care Navigation team. Build relationships with brokers, carriers and TPAs; monitor client health and KPIs; lead renewals, upsells and QBRs; resolve escalations; drive cross-functional collaboration; and translate data into actionable insights to improve client outcomes and retention.

Own client-facing technical implementation and support across SSO, file transformations, provider networks, engagement platforms, and eligibility workflows. Configure and validate systems, monitor file ingestion, investigate registration and data-quality issues, resolve standard problems, and coordinate escalations with engineering teams. Maintain implementation records, SOPs, knowledge bases, and QA checklists while partnering with Client Success, Implementation, Data Engineering, and Product to improve tooling and processes.

Create and manage branded digital and print assets across websites, email, social media, presentations, events, and marketing collateral. Serve as a brand steward, maintain design standards, develop scalable templates and guidelines, and ensure usability, accessibility, and performance. Collaborate cross-functionally, manage multiple projects and deadlines, review external assets, and support commercial and member marketing teams with impactful visual communications.

Manage key client relationships in the Pharmacy Benefit Management sector, ensuring high-quality service delivery and client satisfaction while coordinating with internal teams and leading client interactions.

Serve as a subject-matter expert for Rightway's Navigation and Unity solutions during client engagements. Support RFPs, pitches, demos, workshops, and enablement; translate client needs into actionable solutions; collaborate across product, delivery, marketing, and sales to drive implementation, optimization, and commercial outcomes.

Manage daily accounting operations (AP, AR, cash, payroll), prepare journal entries and reconciliations, support month-end and year-end close, assist with financial statements, audit preparation, sales/use tax filings, and cross-functional projects to improve processes and reporting.

Sell Rightways PBM and Navigation solutions to large, self-funded Fortune 500 employers in the Eastern U.S. Build pipeline, close deals, manage RFP-to-contract process, and coordinate cross-functional teams to onboard clients. Represent the company at industry events and use Salesforce to track sales activities.

Lead design and productionalization of AI-driven features for care navigation and PBM. Rapidly prototype and ship full-stack solutions using Node.js, React, TypeScript, Ruby, GraphQL, and Postgres. Architect scalable, secure systems for sensitive healthcare data, set AI integration standards, drive technical decisions, and mentor engineers to ensure production-quality implementations.