Product Manager – Medicare Claims & Premium Billing (Facets)

Contract:  Contract To Hire

Duration: 6 month contract period with Axiom – W2 or 1099, then role permanent with client.

Start:   Early October 2025

Not available to: H1B or 3rd Party Vendors

Overview

AXIOM Systems is seeking a Product Manager with Medicare Claims & Premium Billing and deep expertise in TriZetto Facets to lead strategy, roadmap, and delivery of Medicare claims payment, premium billing, and member Explanation of Benefits (EOB) capabilities. This role combines product management, Medicare operational knowledge, and strong technical skills in SQL, SSIS, and Azure Data Factory to ensure compliance, accuracy, and efficiency. The ideal candidate will also oversee vendor integrations (Zelis or similar) to support invoicing, claims payment correspondence, and member communication distribution.

Key Responsibilities

• Define and execute the product roadmap for Medicare claims payment, premium billing, and member EOBs in Facets.
• Translate CMS regulations and Medicare operational requirements into business and system requirements.
• Work hands-on with SQL, SSIS, and Azure Data Factory to validate data, troubleshoot ETL workflows, and support integrations.
• Manage vendor relationships (e.g., Zelis) for invoice and EOB fulfillment; ensure compliance with SLAs.
• Monitor end-to-end claims payment workflows, driving accuracy, automation, and efficiency.
• Lead testing and implementation of premium billing features in Facets, including benefit configuration, invoice generation, payment posting, and reconciliation.
• Ensure CMS-compliant member communications, leveraging templates, audits, and member experience standards.
• Collaborate across Operations, DTS, Finance, and Compliance to resolve production issues and deliver enhancements.
• Develop reporting and analytics dashboards to track KPIs (e.g., payment accuracy, billing accuracy, fulfillment timeliness).
• Serve as a subject matter expert (SME) on Facets, Medicare billing, and technical integrations.

Requirements

• 5+ years in Product Management within healthcare payer systems.
• 5+ years direct experience with TriZetto Facets.
• Strong knowledge of Medicare Advantage claims payment, EOB generation, and premium billing.
• Hands-on expertise with:
  • Microsoft SQL (queries, optimization, audits)
  • Microsoft SSIS (ETL workflows, data integration)
  • Azure Data Factory (pipelines and transformations)
• Experience with fulfillment vendors (Zelis or similar).
• Strong understanding of CMS compliance for claims and member communications.

Education

• Bachelor’s degree in information systems, Computer Science, Business, Healthcare Administration, or related field (or equivalent experience).
• MBA or advanced degree preferred.

Preferred Skills

• Deep knowledge of Facets adjudication, workflows, EXCD codes, pend/release, adjustments, recoveries.
• Experience with Medicare operations, STAR ratings, CMS audit readiness.
• Familiarity with HIPAA EDI standards (837/835/820) and file protocols.
• Vendor management and SLA oversight.