Alignment Health · 3 days ago
Technical Product Manager – Facets Payment Solutions
United States
Full-time
Remote
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 drive the strategy and delivery of Medicare claims payment and member communications, requiring a blend of product management and technical skills to ensure compliance and efficiency.
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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, including Medicare 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
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 knowledge of Medicare Advantage claims payment, EOB generation, and premium billing workflows
Proven hands-on expertise with Microsoft SQL (querying, optimization, reconciliation, audits)
Proven hands-on expertise with Microsoft SSIS (ETL workflows and data integration)
Proven hands-on expertise with 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
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 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
Preferred
MBA or advanced degree
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