Remote Sr. Compliance Specialist Delegation Oversight

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.

Remote -Sr Compliance Specialist, Delegation Oversight supports the Manager, Audit Administration by performing critical monitoring, validation, and documentation activities that strengthen Alignment Healthcare’s oversight of delegated entities. In this role, the Specialist contributes to the Delegation Oversight Department’s performance‑driven monitoring program by collecting, verifying, and analyzing required reports to ensure ongoing delegate compliance with regulatory and contractual requirements. The Specialist monitors delegate performance (e.g. timeliness of prior authorization (PA) and claims processing) and records all monitoring outcomes in designated tracking systems with a high degree of accuracy and audit readiness. The role is also responsible for identifying data discrepancies, obtaining necessary corrections, and collaborating with delegated entities to ensure issues are resolved and corrective actions prevent recurrence. Through consistent documentation, analytical evaluation, and adherence to monitoring methodologies, the Sr. Compliance Specialist helps maintain organizational compliance, operational integrity, and a strong internal control environment across all delegated functions.

Job Duties/Responsibilities:

• Retrieves, reviews, and validates all required reports submitted by delegated entities, including ODAG, Part C ODR, and claims Monthly Timeliness Reports (MTR), to ensure completeness, accuracy, and compliance with Medicare Advantage and contractual reporting standards.
• Identifies reporting deficiencies or discrepancies and communicates findings to delegated entities in a clear and timely manner; follows through to ensure corrected files are submitted and fully resolved in accordance with established audit protocols.
• Supports Quarterly Part C ODR reporting, including:
  • Maintaining an accurate receipt tracker of all delegate submissions.
  • Completing the master tracker of aggregate data for internal and external review.
  • Preparing accurate and audit‑ready reports for DTS and CMS submission, in alignment with regulatory deadlines and formatting requirements.
• Distributes updated member notice templates and ensures proper delegate adoption and implementation. This includes:
  • Tracking receipt of templates and associated attestations.
  • Reviewing submitted samples for accuracy, compliance, and appropriate use of templates.
  • Communicating results to delegated entities, monitoring corrective actions, and validating completion of required updates.
  • Providing timely status updates to the Manager regarding sample results, recurring issues, and delegate performance trends.
• Supports the retrieval, review, and interpretation of shared audit results (e.g., HICE) and completes all required follow‑up activities, including documenting findings, coordinating corrective actions with delegated entities, and ensuring closure in accordance with established audit protocols.
• Supports department-wide communications by drafting and distributing announcements, guidance documents, updated/new templates, and email blasts to delegated entities; tracks all responses, maintains organized records of required submissions, and reports any risks, delays, or compliance concerns to leadership.
• Participates in CMS Program Audits and other regulatory or internal audits by preparing required documentation, compiling evidence, supporting data validation activities, and assisting in remediation efforts as assigned by the Manager, Audit Administration.

Job Requirements:

Experience:

• 5 years’ experience in a Medicare Advantage Plan environment.
• 4 to 5 years’ experience with MA reporting requirements, delegation oversight, compliance, or other oversight processes.

Education:

• Required: High school diploma or GED

• Preferred: AA or Bachelor's degree, or four years additional experience in lieu of education.

Training:

• Required: None

• Preferred: None

Specialized Skills:

• Required:

• Interpersonal & Collaboration Skills: Demonstrated ability to communicate in a positive, professional, and effective manner; capable of guiding, educating, and collaborating with delegated entities to foster collaboration and ensure compliance.
• Advanced Communication Skills: Strong written and verbal communication skills, with the ability to clearly convey complex information, draft structured guidance, and provide concise explanations of findings, discrepancies, and requirements.
• Mathematical & Statistical Competency: Ability to accurately perform mathematical calculations and compute basic statistical measures to validate report accuracy and identify trends or anomalies.
• Analytical & Reasoning Skills: Proven ability to prioritize multiple tasks, apply advanced reasoning to define problems, collect and interpret data, evaluate information, draw logical conclusions, and recommend actionable solutions.
• Problem‑Solving & Organizational Skills: Strong problem‑solving capabilities with effective time‑management and organization; able to work efficiently in a fast‑paced environment while maintaining high accuracy and attention to detail.
• Report Review & Data Analysis Skills: Ability to read, interpret, and analyze statistical and operational reports; identify discrepancies; and provide clear, data‑driven feedback to internal stakeholders and delegated entities.

Licensure:

• Required: None

Other:

• Required: None

Essential Physical Functions:

The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job.  Reasonable accommodation may be made to enable individuals with disabilities to perform the essential functions.

1.  While performing the duties of this job, the employee is regularly required to talk or hear. The employee regularly is required to stand, walk, sit, use hand to finger, handle or feel objects, tools, or controls; and reach with hands and arms.

2. The employee frequently lifts and/or moves up to 10 pounds. Specific vision abilities required by this job include close vision and the ability to adjust focus.

Pay Range: $58,531.00 - $87,797.00

Pay range may be based on a number of factors including market location, education, responsibilities, experience, etc.

Alignment Health is an Equal Opportunity/Affirmative Action Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, age, protected veteran status, gender identity, or sexual orientation.

*DISCLAIMER: Please beware of recruitment phishing scams affecting Alignment Health and other employers where individuals receive fraudulent employment-related offers in exchange for money or other sensitive personal information. Please be advised that Alignment Health and its subsidiaries will never ask you for a credit card, send you a check, or ask you for any type of payment as part of consideration for employment with our company. If you feel that you have been the victim of a scam such as this, please report the incident to the Federal Trade Commission at https://reportfraud.ftc.gov/#/. If you would like to verify the legitimacy of an email sent by or on behalf of Alignment Health’s talent acquisition team, please email careers@ahcusa.com.