Technical Product Manager - Claims

Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve. In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.The Technical Product Manager position requires an individual to be a claims subject matter expert on the Tri-Zetto Facets claims platform. This position will drive the strategy, roadmap, and delivery of Medicare claims payment. This role combines deep functional knowledge of member, provider, and claims operations with technical expertise in automation, APIs, and integration. The Technical Product Manager will ensure the plat-form delivers scalable, compliant, and efficient solutions to support Medicare claims adjudication, payment timeliness and accuracy.Job Duties/Responsibilities:Drive the functional and technical roadmap for the Trizetto Claims platform, ensuring alignment with Medicare business priorities, CMS requirements, and enterprise technology goals.Anticipate regulatory and operational changes (e.g., CMS rule updates, encounter data submission requirements) and integrate them into the roadmap.Lead the design, testing, and implementation of new features in Facets.Oversee configuration of benefits, plan designs, pricing logic, provider contracts, and payment rules.Define requirements for batch jobs, APIs, and EDI transactions (837, 835, 277, 999) to support claims, member, and provider data flows.Translate CMS regulations and Medicare operational requirements into actionable business and system requirements.Partner with vendors to manage technical solutions and integrations, ensuring compliance with service-level agreements (SLAs).Monitor end-to-end claims payment workflows, ensuring accuracy and identifying opportunities for automation and efficiency.Serve as the functional-technical bridge between DTS, Claims Operations and Trizetto vendor teamsJob Requirements:Experience:5+ years of Product Management or Business Analyst experience in healthcare payer systems, with at least 3 years focused on TriZetto Facets.Strong functional expertise in Medicare claims processing, provider contracting/setup, and Medicare member configuration and attributes.Proven hands-on expertise with:Microsoft SQL (querying, optimization, reconciliation, audits)ETL Tools such as Microsoft SSIS and Azure Data FactoryJob Scheduling tools such as Redwood, Tidal and Control-MCloud Platforms (Azure/AWS)Experience integrating vendor solutionsSolid understanding of what drives Claims compliance in a Medicare environment.Strong analytical, problem-solving, and communication skills with the ability to translate technical details into business outcomes.Education:Bachelor’s degree in Information Systems, Computer Science, Business, Healthcare Administration, or related field.  4 years additional experience may be considered in lieu of educationMBA or advanced degree preferred.Specialized Skills:Facets claims adjudication steps, Facets Workflow, EXCD codes, Warning Messages, Pend/Release processes, adjustments and recoveries.Experience with premium billing systems and CMS Late Enrollment Penalty (LEP) processingHands-on involvement in provider dispute workflows, appeals management, and portal integration.Familiarity with EDI standards and file protocols (HIPAA 837/835/820, XML, PDF fulfillment).Vendor management and SLA performance oversight.Pay Range: $113,332.00 - $169,999.00Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc. Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.