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 subject matter expert with TriZetto Fac-ets. This position will drive the strategy, roadmap, and delivery of Medicare claims payment, member Expla-nation of Benefits (EOB) communications, and member premium billing capabilities. This role blends product management, Medicare operational expertise, and hands-on technical skills in SQL, SSIS, and Azure Data Fac-tory to ensure accuracy, compliance, and scalability. A key responsibility will be managing integration and fulfillment processes with Zelis for premium invoicing, claims payment correspondence, and member EOB distribution.
Job Duties/Responsibilities:
- Define and execute the product roadmap for Medicare claims payment, premium billing, and member EOBs within the Facets platform.
- Translate CMS regulations and Medicare operational requirements into actionable business and system requirements.
- Work hands-on with SQL, SSIS, and Azure Data Factory to validate data, support ETL workflows, and troubleshooting issues across claims, billing, and fulfillment processes.
- Partner with Zelis to oversee file integrations, distribution of invoices and EOBs, ensuring compliance with service-level agreements (SLAs).
- Monitor end-to-end claims payment workflows, ensuring accuracy and identifying opportunities for automation and efficiency.
- Lead the design, testing, and implementation of premium billing features in Facets, includingMedicare product benefit configuration, billing entities, invoice generation, member payment posting, and reconciliation.
- Ensure Medicare member communications (EOBs, premium bills, payment notices) meet CMS guidelines, leverage CMS model templates, integrate audit requirements, and understand member experience standards.
- Collaborate with DTS, Operations, Finance, and Compliance leadership to resolve production issues and deliver enhancements.
- Provide requirements, develop and maintain reporting and analytics dashboards to track KPIs such as claims payment accuracy, billing accuracy, fulfillment timeliness, and member impact.
- Act as SME for internal stakeholders on Facets, Medicare billing, and technical integrations.
Job 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 knowledge of Medicare Advantage claims payment, EOB generation, and premium billing workflows.
- Proven hands-on expertise with:
- Microsoft SQL (querying, optimization, reconciliation, audits)
- Microsoft SSIS (ETL workflows and data integration)
- Azure Data Factory (cloud-based pipelines and transformations)
- Experience integrating or managing fulfillment vendors (Zelis or similar).
- Solid understanding of CMS compliance requirements for member communications and claims.
- 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 education
- MBA or advanced degree preferred.
Specialized Skills:
- Facets claims adjudication steps, Facets Workflow, EXCD codes, Warning Messages, Pend/Release processes, adjustments and recoveries.
- Experience with Medicare operations, STAR ratings, and CMS audit readiness.
- 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 - $169,999.00
Pay 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.
Originally posted on Himalayas