Alignment Health · 5 days ago
Technical Product Manager - Claims
United States
Full-time
Remote
Mid, Senior Level
$113K/yr - $170K/yr
5+ years expAlignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. The Technical Product Manager will be responsible for driving the strategy and delivery of Medicare claims payment, ensuring efficient and compliant solutions are in place for claims adjudication.
Health CareHospitalMedicalMedical DeviceWellness
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 teams
Qualification
Required
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
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
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) processing
Hands-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
Preferred
MBA or advanced degree preferred
Company
Alignment Health
Alignment Health provides eldercare services.
501-1000 employees
H1B Sponsorship
Alignment Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (12)
2023 (17)
2022 (13)
2021 (11)
2020 (6)
Funding
Current Stage
Public CompanyTotal Funding
$696.05MKey Investors
K2 HealthVenturesWarburg PincusGeneral Atlantic
2024-11-15Post Ipo Debt· $321.05M
2024-01-09Private Equity
2021-03-26IPO
Leadership Team
Dawn Maroney
President, Markets & CEO of Alignment Health Plan
John Kao
CEO and Founder
Recent News
Alignment Healthcare USA, LLC
2025-10-31
Company data provided by crunchbase