Technical Product Manager – Provider Solutions

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October 16

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Alignment Health

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Healthcare Insurance • Insurance • Healthcare

Alignment Health is dedicated to providing comprehensive care for Medicare members, emphasizing the needs of seniors, the chronically ill, and those who are frail. With a mission to transform senior healthcare, Alignment Health leverages a tailored care model and advanced technology to deliver high-quality, low-cost healthcare services. Their 24/7 concierge care team collaborates with trusted local providers to ensure that every member receives personalized care, reflecting the company's commitment to treating all members as valued family members.

501 - 1000 employees

Founded 2013

⚕️ Healthcare Insurance

💰 $135M Series C on 2020-03

📋 Description

• Drive the functional and technical roadmap for Provider Solutions on Alignment’s AVA and Claims platforms • Anticipate regulatory and operational changes and integrate them into the roadmap • Lead the design, testing, and implementation of new features for Provider platforms • Oversee configuration of provider contracts, capitation and claims payment rules • Define requirements for interface integration between platforms, APIs, and EDI X12 transactions • Translate CMS regulations and Medicare operational requirements into actionable business and system requirements • Partner with vendors to manage technical solutions and integrations • Monitor end-to-end Provider workflows • Serve as the functional-technical bridge between DTS, Business Operations and network/provider engagement teams

🎯 Requirements

• 5+ years of Product Management or Business Analyst experience in healthcare payer systems • At least 3 years focused on TriZetto Facets • Strong functional expertise in Provider contracting, capitation arrangements, claims and payment reimbursement • Proven hands-on expertise with Microsoft SQL, ETL Tools such as Microsoft SSIS and Azure Data Factory, Job Scheduling tools such as Redwood, Tidal and Control-M, Cloud Platforms (Azure/AWS) • Experience integrating vendor solutions • Solid understanding of compliance in a Medicare environment • Strong analytical, problem-solving skills • Excellent communication skills • 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)

🏖️ Benefits

• Health insurance • Paid time off • Professional development opportunities