Associate Vice President, Claim Accuracy

Position: Associate Vice President, Claim Payment Accuracy
Alignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most: the chronically ill and frail. It takes an entire team of passionate and caring people, united in our mission to put the senior first. We have built a team of talented and experienced people who are passionate about transforming the lives of the seniors we serve.

In this fast-growing company, you will find ample room for growth and innovation alongside the Alignment Health community. Working at Alignment Health provides an opportunity to do work that really matters, not only changing lives but saving them. Together.

The Associate Vice President, Claim Payment Accuracy owns the enterprise discipline for identifying, prioritizing, and permanently remediating issues that cause claims to pay incorrectly. This is an operational excellence and transformation role, not a day-to-day claims production or quality assurance role. The AVP leads cross-functional work from signal and root cause through corrective action, validation, and sustained control.

The role partners across Payment Integrity, Claim Audit, Claim Operations, Configuration, Technology, Data, Finance, Compliance, Network, and other claim-adjacent functions. Its north star is to reduce avoidable payment leakage and systematically decrease reliance on retrospective Payment Integrity recovery by fixing upstream process, configuration, data, policy, and technology defects.

Fraud, waste, and abuse activities may sit within the organization led by this role; however, the AVP is accountable for the broader claim payment accuracy agenda. Success requires strong analytics, disciplined problem solving, executive influence, and the ability to drive changes across teams without relying solely on direct authority.

Job Duties / Responsibilities Own the Claim Payment Accuracy Agenda
· 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.

Lead Root-Cause Analytics and Insight
· 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. Hands-on coding is not required, but the AVP must be able to challenge methods, interpret results, and direct analysts.

Drive Remediation from Discovery to Sustainability
· 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…