Alignment Health

Auditor

• Conduct audits in accordance with regulatory, contractual, and industry standards
• Execute detailed claims audits using established methodologies, sampling frameworks, and documentation standards to ensure accuracy, consistency, and regulatory readiness
• Communicate audit scope, expectations, and timelines clearly to delegated provider organizations throughout the audit lifecycle
• Review and validate Corrective Action Plans (CAPs) submitted by delegated entities to ensure remediation fully addresses identified deficiencies

Auditor, Delegate Claims

Business Development Rep

• Develops and executes growth strategies to expand market presence
• Leads and manages strategic provider agreements
• Designs innovative contracting models
• Analyzes and shapes reimbursement strategies
• Collaborates with teams to achieve targeted growth

VP, Business Development

IT Support

• Design Audit and Monitoring Strategy.
• Develop an annual, risk based‑ audit and monitoring strategy for all delegated provider functions.
• Integrate inputs from subject matter experts, operational leaders, and monitoring data to ensure audit plans are targeted, evidence based, and aligned with organizational priorities.
• Implement Audit and Monitoring Activities.
• Lead, train, and align auditors and specialists to ensure consistent application of audit methodologies, tools, and strategies.
• Cross-Functional Collaboration & Integration.
• Partner with Delegate Performance, clinical operations, quality, compliance and other internal teams to align audit expectations with operational goals and performance initiatives.
• Reporting, Insights & Continuous Improvement.
• Develop clear, concise, and executive‑ready audit reports, dashboards, and summaries that highlight key risks, patterns, and performance trends across delegated entities.

Senior Manager, Audit Administration

Project Manager

• Support the Delegation Oversight & Performance team by coordinating and executing projects that advance the organization’s performance focused oversight model.
• Synthesize data to produce actionable delegate performance scorecard.
• Validate data for completeness, accuracy, and alignment with established performance indicators before integrating into reporting tools.
• Translate raw data into organized, easy‑to‑understand visuals and summaries that support performance discussions with the Manager, Director, and delegated entities.
• Maintain documentation and audit trails for all data sources, methodologies, and version histories to support transparency and regulatory readiness.
• Build and maintain performance matrices that highlight key trends, risks, and operational gaps across delegated functions.
• Lead project management efforts for department initiatives such as technology enhancements, system transitions, workflow redesigns, and process improvements.

Project Manager, Delegate Performance

Compliance

• Supports the Manager, Audit Administration by performing monitoring, validation, and documentation activities
• Monitors delegate performance and ensures compliance with regulatory and contractual requirements
• Retrieves, reviews, and validates all required reports submitted by delegated entities
• Identifies reporting deficiencies and communicates findings to delegated entities
• Supports Quarterly reporting and maintains data accuracy

Senior Compliance Specialist – Delegation Oversight

Data Engineer

• Translates business requirements into specifications that will be used to implement the required data load (ETL), reports and dashboards.
• Gathers business requirements, development and delivery of business intelligence & reporting services and lead end to end BI delivery.
• Develops and implements business intelligence, analytics, and dashboards using out-of-box features customizations and visualizations to support organizational initiatives.
• Designs, models, develops & optimizes stored procedures to meet data management and data load and reporting objectives.
• Designs and models data flows and ETL procedures ensuring data quality and integrity.
• Ensures data sets feeding the analytics platforms are tuned for optimal performance.
• Works with power users of the analytics/reporting tools to advise on best practices for Business Intelligence reporting.
• Troubleshoots and resolves issues with the processes used and the content produced by the BI platform.
• Works with business stakeholders to define and improve standardized and ad-hoc analytics/reporting capabilities.
• Works as part of the BI team to maintain and develop all components of the BI platform.
• Provides ongoing maintenance support through troubleshooting, report modifications and optimization.
• Provides input into the technical architecture and the data warehouse technology stack.
• Creates functional and technical design documents and maintains documentation for all reports and dashboards created or modified.
• Responsibilities include orienting and training employees; assigning workload; planning, monitoring, and appraising job results; and coaching, counseling, and disciplining employees.

Manager, Data Engineering

Manager

• Own the end-to-end performance management process for delegated entities
• Conduct ongoing trend analysis to identify performance risks or improvement opportunities
• Lead performance discussions with delegated partners
• Collaborate with cross-functional teams

Manager, Delegate Performance

• Conduct UM/CM audits in accordance with regulatory, contractual, and industry standards
• Execute Utilization Management (UM) and Case Management (CM) audits using established methodologies, sampling criteria, and documentation standards to ensure accuracy, consistency, and regulatory readiness.
• Evaluate delegated entities’ compliance with CMS and contractual requirements, and Alignment Healthcare’s UM/CM policies and standards.
• Maintain organized, complete, and audit‑ready documentation to support regulatory, accreditation, and internal oversight reviews.

Auditor, Delegate UM/CM

• Conduct credentialing audits in accordance with regulatory, contractual, and industry standards
• Execute delegated credentialing audits using established methodologies, sampling criteria, and documentation standards to ensure accuracy, consistency, and regulatory readiness.
• Evaluate delegated entities’ compliance with CMS, DMHC, NCQA, federal/state credentialing requirements, and Alignment’s contractual standards.
• Maintain organized, complete, and audit-ready documentation to support regulatory reviews, accreditation audits, and internal oversight.
• Ensure all audit activities align with the enterprise audit strategy set by the Manager, Audit Administration.
• Engage delegated provider organizations to correct deficiencies and improve performance
• Communicate audit scope, expectations, and timelines clearly to delegated provider organizations throughout the audit lifecycle.
• Provide delegates with clear explanations of audit findings, including root causes, compliance gaps, and potential operational impacts.
• Support delegated entities in understanding credentialing requirements and expectations for corrective actions.
• Promote productive and professional working relationships to foster transparency, collaboration, and continuous improvement.
• Perform risk assessment and prioritize audits
• Assist in identifying high-risk focus areas by reviewing prior audit results, monitoring data, and operational issues related to credentialing performance.
• Recommend audit prioritization based on risk severity, regulatory sensitivity, and emerging compliance trends.
• Provide input to refine audit scopes and schedules in alignment with the Manager’s risk-based audit and monitoring strategy.
• Escalate emerging risks or irregular credentialing issues to the Manager, Audit Administration for strategic review and inclusion in future audit planning.
• Validate corrective actions for credentialing compliance
• Review and validate Corrective Action Plans (CAPs) submitted by delegated entities, ensuring remediation fully addresses identified credentialing deficiencies.
• Assess evidence such as updated credentialing files, process changes, workflow revisions, and policy updates to confirm compliance with regulatory and contractual standards.
• Track CAP progress and ensure follow-up activities are completed and documented according to departmental requirements.
• Escalate irregular, incomplete, or stalled CAPs to the Manager, Audit Administration to support timely issue resolution.
• Report credentialing audit findings to facilitate organizational awareness
• Prepare clear, concise, and well-structured audit summaries highlighting key risks, deficiencies, and improvement opportunities across delegated credentialing practices.
• Contribute to department-standard reporting tools, dashboards, and audit documentation used for leadership and cross-functional communication.
• Partner with Delegate Performance, Clinical Operations, Quality, Compliance, and other internal teams to ensure findings are understood and actionable.
• Support preparation of materials for internal committees, regulatory bodies, and enterprise risk-management forums.
• Manage multiple credentialing audits simultaneously, ensuring adherence to timelines, scope, and quality standards.
• Monitor credentialing-related data to identify emerging trends, potential non-compliance, and areas requiring targeted review.
• Contribute subject-matter insights during training or education sessions for delegated entities to reinforce credentialing expectations and reduce recurring deficiencies.
• Support compilation of documentation and evidence for CMS, NCQA, or other regulatory audits.
• Perform additional responsibilities and projects as assigned.

Auditor – Delegate Credentialing

Data Analyst

• Maintain the data integrity of Alignment Healthcare’s provider database
• Inputs, uploads and updates provider demographic information
• Assures the accuracy of the provider information
• Processes Change of Information requests electronically
• Assists in producing and filing all provider directories
• Places calls to verify demographic information

Provider Data Analyst

Customer Support

• Build caring connections with every member by always leading with empathy, patience, and respect, ensuring members feel heard, supported, and valued throughout every interaction.
• Own each member interaction end-to-end, taking accountability to resolve inquiries during the initial contact and ensuring clear follow-through when additional steps are required.
• Deliver exceptional service by consistently exceeding member expectations and reinforcing a culture focused on trust, compassion, and first-call resolution.
• Accurately respond to member inquiries regarding benefits, eligibility, services, policies, and procedures in a clear, confident, and member-friendly manner.
• Assist members with provider network and claim/reimbursement inquiries, benefit questions related to transportation, food, dental and other support services and needs, proactively identifying solutions and next steps.
• Answer incoming contacts within established service levels while always managing complex and sensitive situations with professionalism and care.
• Thoroughly document all member interactions, actions taken, and outcomes in real time to ensure accuracy, continuity of care and effective resolution.
• Proactively address member complaints, grievances, and disenrollment concerns with goal to resolve by listening for root causes, offering solutions, and escalating appropriately when needed.
• Support outbound outreach initiatives and service programs designed to improve engagement, education, and overall member experience.
• Represent Alignment Healthcare with integrity and positivity, modeling a serving-heart mindset and commitment to excellence in every interaction.
• Participate actively in ongoing coaching, feedback, and learning to continuously strengthen service skills and member advocacy.

Bilingual Customer Experience Specialist, Mandarin

• Build caring connections with every member by always leading with empathy, patience, and respect, ensuring members feel heard, supported, and valued throughout every interaction.
• Own each member interaction end-to-end, taking accountability to resolve inquiries during the initial contact and ensuring clear follow-through when additional steps are required.
• Deliver exceptional service by consistently exceeding member expectations and reinforcing a culture focused on trust, compassion, and first-call resolution.
• Accurately respond to member inquiries regarding benefits, eligibility, services, policies, and procedures in a clear, confident, and member-friendly manner.
• Assist members with provider network and claim/reimbursement inquiries, benefit questions related to transportation, food, dental and other support services and needs, proactively identifying solutions and next steps.

Bilingual Customer Experience Specialist – Vietnamese

• Delivers highly engaging virtual instructor-led training (VILT) sessions focused on customer experience, communication skills, empathy, de-escalation, and service excellence
• Leads multi-week VILT new hire onboarding in addition to ongoing training classes for existing employees
• Facilitates interactive learning experiences using adult learning principles, storytelling, and real-world scenarios
• Coaches and mentors customer-facing teams driving continuous improvement at all levels
• Creates and maintains high-quality training content in collaboration with the Customer Experience Training team’s goals

Customer Experience Trainer

Director

• Responsible for meeting the network management needs for assigned geography and/or health delivery networks
• Working closely with the regional executive teams, and leading the market’s clinical performance activity
• Offers technical leadership and expertise to both regional and corporate initiatives
• Oversees Regional Performance of Network
• Leads and facilitates join operations committee meetings (JOC)
• Reviews, analyzes and develops strategies based on historical performance data
• Trains and manages direct reports to capture and document provider interactions
• Collaborates with regional executive team and other departments to ensure contracted network support of operating goals

Director, Network Management

• Build caring connections with every member by always leading with empathy, patience, and respect.
• Own each member interaction end-to-end, taking accountability to resolve inquiries during the initial contact.
• Deliver exceptional service by consistently exceeding member expectations and reinforcing a culture focused on trust, compassion, and first-call resolution.
• Accurately respond to member inquiries regarding benefits, eligibility, services, policies, and procedures in a clear, confident, and member-friendly manner.
• Assist members with provider network and claim/reimbursement inquiries.