AVP, Claim Payment Integrity & Analytics

E2E Alignment Healthcare USA, LLC; United States; On-site; USD 198,000 - 297,000; Full time

Job summary

Alignment Health is seeking a senior leader to own the Claim Payment Accuracy agenda and lead analytics-driven remediation across the organization. You will establish governance, drive cross-functional remediation, and translate findings into preventive actions, partnering with Finance, Operations, and Technology.

The role requires a deep understanding of health plan claims, strong executive communication, and the ability to influence senior leaders without direct authority.

Qualifications

• 10+ years in health plan claims, payment integrity, or related field.
• 5+ years leading teams or cross-functional programs.
• Experience with governance, portfolio management, and executive reporting.
• Strong analytical orientation using claims, financial, operational, or audit data to size problems and validate outcomes.
• Ability to influence senior leaders and maintain accountability across teams without direct reporting authority.
• Executive-level communication skills and ability to present concise, decision-ready findings.

Responsibilities

• Define and lead the enterprise claim payment accuracy strategy, governance, and multiyear roadmap.
• Establish a transparent portfolio of known and emerging payment issues across multiple domains.
• Create a method to size, prioritize, and sequence issues by impact and remediation complexity.
• Define accountability, escalation paths, and closure criteria for remediation work.
• Build an analytics-led capability to connect data sources to identify systemic payment defects.
• Translate recoveries and audit findings into root-cause themes and actionable fixes.
• Lead structured root-cause analysis across people, process, and technology dimensions.
• Convert findings into funded remediation plans with milestones and controls.
• Coordinate implementation across multiple internal functions and validate results.
• Provide oversight for FWA within the function and ensure coordination with leadership.

Skills

Leadership

Analytics

Root-cause analysis

Program management

Executive communication

Cross-functional collaboration

Education

Bachelor's degree in business, healthcare administration, analytics, finance, information systems, engineering, or related field

Tools

SQL

Data visualization

Job description

Alignment Health is seeking a senior leader to own the Claim Payment Accuracy agenda and lead analytics-driven remediation across the organization. You will establish governance, drive cross-functional remediation, and translate findings into preventive actions, partnering with Finance, Operations, and Technology.

The role requires a deep understanding of health plan claims, strong executive communication, and the ability to influence senior leaders without direct authority.