Alignment Healthcare Benefits Overview

Leads the discovery, architecture, development, deployment, support, and optimization of workflow automation and AI-enabled solutions. Partners with operations leaders to improve processes, define requirements, integrate systems, and deliver scalable RPA, low-code, API, document-processing, and approved AI solutions. Provides technical leadership, ensures security and governance compliance, supports adoption, and measures business outcomes. This hands-on role does not involve machine learning model development or advanced predictive analytics.

Leads a team supporting member digital communications, reimbursement processing, grievances, and appeals. Oversees coaching, onboarding, performance management, regulatory compliance, documentation accuracy, turnaround times, quality, and member satisfaction. Analyzes operational trends, develops improvement plans, ensures CMS and HIPAA compliance, and collaborates with Operations, Technology, and Compliance teams to improve resolution workflows and digital service delivery.

Performs advanced actuarial analysis, financial modeling, reserving, forecasting, risk adjustment, Part D, bid review, and pharmacy analytics. Analyzes healthcare costs, utilization trends, and financial risks; validates data across sources; supports pricing, budgeting, and regulatory reporting. Partners with finance, pharmacy, clinical, operations, and Medicare risk-adjustment teams, translating complex actuarial findings into actionable reports, dashboards, presentations, and business insights.