Senior AVP, Enterprise Claim Payment Accuracy

Alignment Healthcare USA, LLC in; Orange (CA); On-site; USD 198,000 - 297,000; Full time

Job summary

Alignment Health in California seeks an Associate Vice President, Claim Payment Accuracy to own the enterprise discipline for identifying and remediating issues that cause claims to pay incorrectly. This is an executive leadership role spanning Payment Integrity, Claim Audit, and related functions.

The AVP will lead analytics-driven remediation, define governance, and partner across teams to reduce leakage, improve data availability, and implement upstream fixes; strong communication with SVP

Qualifications

• 10+ years in health plan claims, payment integrity or related field, with 5+ years leading teams.
• Strong governance, executive reporting and cross-functional influence.
• Experience with Medicare Advantage and CMS claim payment preferred.
• Bachelor's degree required; master's preferred.

Responsibilities

• Define and lead the enterprise claim payment accuracy strategy, operating model, governance, and multiyear roadmap.
• Establish a single, transparent portfolio of known and emerging payment issues across prepay, postpay, audit, operations, configuration, provider, and FWA signals.
• Create a consistent method to size, prioritize, and sequence issues based on financial exposure, member and provider impact, compliance risk, recurrence, and remediation complexity.
• Define clear accountability, decision rights, escalation paths, and closure criteria for cross-functional remediation work.
• Build and direct an analytics-led capability that connects recovery, audit, adjustment, denial, configuration, provider, and operational data to identify systemic payment defects.
• Translate Payment Integrity recoveries and Claim Audit findings into root-cause themes, quantified exposure, and actionable upstream fixes.
• Distinguish isolated errors from recurring patterns and enterprise defects, and focus resources on issues with the greatest preventable value.
• Develop practical measurement for payment accuracy, defect recurrence, time to remediation, prevented loss, and sustained financial impact.
• Partner with Data and Technology teams to improve data availability, traceability, and analytical tooling.
• Lead structured root-cause analysis across people, process, policy, configuration, data, vendor, and technology dimensions.
• Convert findings into funded, owned remediation plans with milestones, dependencies, controls, and measurable outcomes.
• Coordinate implementation across Claim Operations, Configuration, Product, Technology, Payment Integrity, Claim Audit, Finance, Network, and other impacted functions.
• Validate that fixes work as intended, quantify prevented value, monitor recurrence, and reopen issues when results are not sustained.

Skills

Analytical leadership

Executive communication

Cross-functional leadership

Problem solving

Data analysis

Education

Bachelor's degree in business/healthcare analytics

Master's degree preferred

Tools

Facets or core claims platform

SQL

Data visualization

Job description

Alignment Health in California seeks an Associate Vice President, Claim Payment Accuracy to own the enterprise discipline for identifying and remediating issues that cause claims to pay incorrectly. This is an executive leadership role spanning Payment Integrity, Claim Audit, and related functions.

The AVP will lead analytics-driven remediation, define governance, and partner across teams to reduce leakage, improve data availability, and implement upstream fixes; strong communication with SVP