Technical Product Manager – Claims

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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 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 teams.

🎯 Requirements

• 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 Factory • Job Scheduling tools such as Redwood, Tidal and Control-M • Cloud Platforms (Azure/AWS) • Experience integrating vendor solutions • Solid 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.