Jobs at Alignment Healthcare

Senior leader responsible for designing, maturing, and operating a data-driven, risk-based enterprise Compliance Program for Medicare Advantage and related lines. Provides strategic regulatory guidance, oversees monitoring, audits, investigations, HIPAA privacy and breach response, compliance training, policy governance, and builds a scalable compliance team and reporting dashboards to drive compliance outcomes and board-level oversight.

The Customer Experience Specialist will provide compassionate service to seniors, resolving inquiries effectively while advocating for members and ensuring clear communication and follow-up.

The Hybrid Customer Experience Lead is responsible for leading customer service operations, supporting team performance, and ensuring high quality care for members. This role includes managing inbound and outbound call experiences, addressing member grievances, and collaborating on staff training and performance standards.

The Senior Software Engineer will develop enterprise-level software applications, lead technical design and implementation, ensure quality deliverables, conduct research, and collaborate across teams. They will drive improvements in system architecture and product features.

The Provider Engagement Specialist develops relationships with providers, enhances satisfaction, drives performance metrics, conducts onboarding, and supports growth through education and resources.

The VP of Internal Audit will direct the internal audit function focusing on SOX compliance, enterprise risk management, and healthcare regulatory oversight. They will lead operational audits, ensure compliance with Medicare Advantage regulations, and drive continuous improvement in internal controls while providing strategic insights to senior leadership and the Audit Committee.

This role involves auditing and compliance for risk adjustment data, conducting reviews of documentation, coder audits, and ensuring regulatory compliance across the organization.

Perform remote QA audits of internal coding analysts and vendors to ensure accurate Medicare Risk Adjustment (HCC/RAF) coding and data submitted to CMS. Analyze audit results, identify training and process improvements, support data validation/reconciliation, and collaborate with Risk Adjustment management to improve coding quality and documentation.

Lead member marketing and communications for assigned programs: design and execute integrated multi-channel campaigns (direct mail, email, SMS, IVR, digital), translate data and behavioral insights into targeted segmentation and messaging, author member-facing communications, measure and optimize campaign performance, present results to senior leadership, and partner cross-functionally to drive program OKRs.

The Hybrid Manager oversees pharmacy technicians, ensuring operational efficiency, supervising performance, coaching team members, and supporting workflow improvements. They ensure compliance with regulations and enhance member satisfaction through collaboration across departments.

The Accounts Payable Specialist handles day-to-day accounts payable tasks including invoice processing, payments, reconciliations, and communication with vendors.

The Senior Tax Analyst ensures compliance with federal, state, and local tax obligations, manages income tax provisions, prepares tax filings, and serves as a key point of contact for audits and regulatory inquiries.

The Principal, Technical Product Management drives product strategy, influences senior stakeholders, and leads cross-functional initiatives within healthcare technology to enhance products for seniors and the chronically ill.

The Data Scientist will develop AI/ML models to enhance healthcare processes, ensuring compliance and quality in clinical documentation.

Remote RN Case Manager providing telephonic care coordination for complex, chronically ill seniors. Conducts comprehensive assessments, develops and implements care plans with PCPs and specialists, facilitates referrals/authorizations, provides education and self-management support, closes gaps in care, resolves provider/claims issues, documents care, and maintains PHI confidentiality.

Handle escalated member disenrollment requests and related quality assurance for Medicare managed care members. Resolve complex member issues, conduct inbound/outbound calls, document outcomes, collaborate with internal departments and vendors, support training, and ensure compliance with CMS and regulatory guidelines.

The Resolution Specialist resolves healthcare insurance claims, manages member issues, and collaborates with departments to improve service delivery and member satisfaction.

Execute detailed delegated claims audits to validate CMS and contractual compliance, document findings, support corrective action plans, prioritize risk-based audits, and report trends. Collaborate with Delegate Performance, Clinical Operations, Quality, and Compliance to drive corrective actions and prepare audit-ready documentation for regulatory and leadership reviews.

Oversee and support Medicare Advantage enrollment operations: research, validate, reconcile, and process enrollments. Serve as subject-matter expert on CMS regulations and systems (MARx/WIPRO), train and support enrollment staff, ensure compliance and data integrity, reconcile membership records and SNP eligibility, handle enrollment denials/RFIs, coordinate with sales/brokers/providers, and maintain documentation and monthly reconciliation files.

Design, build, and maintain high-volume data pipelines and integrations between Oracle Cloud Financials and the enterprise data ecosystem (Azure Data Lake, Snowflake). Ensure secure, compliant financial data flows, support reporting infrastructure, act as Tier 3/4 escalation for incidents, and lead integration workstreams through implementation and continuous improvement using scripting, DevOps, and automation.