Jobs at Alignment Healthcare

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.

Leads analytics strategy, reporting, and data product delivery while managing an analytics team and portfolio. Designs scalable solutions, performs complex analysis, validates data, resolves issues, and provides executive reporting. Establishes analytics standards, roadmaps, prioritization, and operating processes; partners across operations, clinical, finance, compliance, and technology. The role improves insight quality and speed, reduces manual work, strengthens data trust, and supports business decision-making.

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 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.

Processes new Medicare plan enrollments, disenrollments, denials, and rejects; validates enrollment data against error reports and CMS files; submits transaction files; conducts data entry; tracks pending applications; communicates with members, CMS, and sales representatives; supports compliance mailings and prepares monthly enrollment reports.

Provides compassionate, end-to-end support to health plan members, primarily older adults and individuals with disabilities. Answers questions about benefits, eligibility, providers, claims, reimbursements, and support services; resolves complaints and grievances; documents interactions; conducts outreach; and follows healthcare and HIPAA requirements. The role requires managing high call volumes, navigating multiple systems, meeting service-level and quality KPIs, and working flexible shifts from a distraction-free Las Vegas-based remote workspace.

Senior executive accountable for end-to-end launch readiness of Medicare Advantage market expansions and enterprise technology implementations. Leads cross-functional governance, program and portfolio management, regulatory compliance, change management, and post-launch stabilization to ensure scalable, compliant operations and exceptional member/provider experiences.

Prepare and review federal, state, and local tax filings; own ASC 740 quarterly and annual tax provisions; manage audits, notices, and external advisors; partner with Accounting, FP&A, Legal, and Operations; monitor tax legislation; improve tax processes, SOX controls, and tax automation using tax and ERP platforms.

Serve as executive IT owner for Oracle Cloud Financials implementation and ongoing operations. Lead end-to-end ERP delivery, integrations (Workday, Azure), SOX/HIPAA compliance, vendor/SI management, data governance, ITIL-aligned support, roadmap and team leadership to support Medicare Advantage finance operations and reporting.

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.

Lead administration and optimization of Oracle EPM/Hyperion Planning and Essbase to support FP&A. Build and maintain data pipelines between Oracle Fusion GL and EPM, create business rules, calc scripts, dashboards, and executive reports. Support predictive planning, ensure SOX/HIPAA governance and cell-level security, provide Tier 3/4 escalation and on-call support during budget and CMS bid cycles, and mentor junior analysts.

Serve as the technical SME for Oracle GL and Financial Close: maintain GL configuration, troubleshoot close and integration issues, automate close workflows, build reconciliation queries and reports, enforce SOX/CMS compliance, and act as tier 3/4 escalation during month-end, quarter-end, and year-end close cycles.

Lead development and management of Medicare Advantage products for assigned markets and segments. Drive benefit design, CMS bid and regulatory activities, market analysis, member communications, go-to-market initiatives, and cross-functional product projects. Track product performance and present insights to leadership to improve membership growth, retention, satisfaction, and financial outcomes.

Lead and coach a team of Customer Experience Specialists in a hybrid contact center to deliver compassionate, end-to-end member support for Medicare Advantage members. Drive KPIs including first-call resolution, quality, schedule adherence, and member satisfaction; oversee workforce management, documentation, escalations, training, hiring, and continuous improvement while ensuring HIPAA and regulatory compliance.

Drive strategy, development, and lifecycle of technical healthcare payer products (STARS/HEDIS focus). Define requirements, lead cross-functional Agile teams, ensure regulatory compliance (CMS/HIPAA), manage vendors, analyze data/metrics, and coordinate launches to deliver business and customer value.

The AVP, Contracting & Network Management will strategize and manage provider network contracts, enhancing healthcare delivery systems and market success while leading a team and collaborating with executives.