Director, Claims Process Excellence - Remote

Alignment Healthcare Inc.; Orange (CA); Remote; USD 130,000 - 195,000; Full time

Job summary

Alignment Health Inc. is seeking a Director of Claims OpEx to lead the enterprise process-improvement strategy for claims operations.

You will collaborate with Operations, IT, Finance, and Compliance to drive automation, governance, and performance improvements across the organization. The role requires 8+ years in health plan claims operations and 3+ years of leadership, with a focus on data-driven decision making, regulatory understanding, and scalable governance.

Qualifications

• 8+ years in health plan claims operations or related healthcare ops.
• 3+ years of people leadership or enterprise program leadership experience.
• Experience translating operational and financial data into executive-level recommendations and roadmaps.
• Experience working in a CMS-regulated environment with knowledge of guidelines and standards.
• Experience scaling teams, governance routines, and cross-functional collaboration.

Responsibilities

• Lead enterprise claims process improvement strategy across the organization.
• Partner with Claims Operations, Configuration, IT, Finance, Compliance, and vendor teams to identify opportunities.
• Develop governance framework, operating model, and performance roadmap for claims improvements.
• Drive automation and technology-enabled process improvements to reduce manual work and errors.
• Deliver measurable outcomes such as improved auto-adjudication, reduced rework, and cost savings.

Skills

Executive presence

Advanced analytical skills

Business case development

Stakeholder management

Delivery risk management

Cross-functional leadership

Regulatory compliance understanding

Education

Bachelor’s degree in Healthcare Administration, Business Administration, Finance, Operations, Information Systems, or related field

Advanced degree or relevant certification in healthcare management, process improvement, project management, analytics, or operational excellence

Tools

Excel

SQL

Power BI

Tableau

Facets

Job description

Alignment Health Inc. is seeking a Director of Claims OpEx to lead the enterprise process-improvement strategy for claims operations.

You will collaborate with Operations, IT, Finance, and Compliance to drive automation, governance, and performance improvements across the organization. The role requires 8+ years in health plan claims operations and 3+ years of leadership, with a focus on data-driven decision making, regulatory understanding, and scalable governance.