Alignment Health · 2 days ago
Quality Assurance Specialist - Non Contracted Provider Appeals
Orange, CA
Full-time
Onsite
Entry Level
$45K/yr - $67K/yr
2+ years expAlignment Health is breaking the mold in conventional health care, committed to serving seniors and those who need it most. The Quality Assurance Specialist is responsible for monitoring and evaluating provider appeal processing activities to ensure accuracy, compliance with regulatory and organizational standards, and overall effectiveness, while supporting high-quality service outcomes for out of network providers.
Health CareHospitalMedicalMedical DeviceWellness
Responsibilities
Validates the accuracy of generated provider response letters
Stays abreast of current workflow quality assurance measures for accurate external communications
Recognizes and identifies possible training issues and error trends; reports findings as required
Ensures HIPAA compliance on all external communications
Audits appeal determinations for upheld and overturn determination by internal and external team members
Will work closely with leadership for daily / weekly / monthly quality assurance reporting through custom reporting tools
Participates in roundtable sessions as needed to review and make recommendations regarding efficiency improvements
Assists with the development of training tools in collaboration with the department trainer; assists with departmental training as needed
Other duties as assigned
Qualification
Required
Minimum of two years of related customer service/telemarketing experience/training; or equivalent combination of education and experience
High School Diploma or GED
Ability to read and interpret documents such as safety rules, operating and maintenance instructions and procedure manuals
Ability to write routine reports and correspondence
Ability to speak effectively before groups of customers or employees of the organization
Ability to add and subtract two-digit numbers and to multiply and divide with 10's and 100's
Ability to perform these operations using units of American money and weight measurement, volume, and distance
Ability to apply common sense understanding to carry out detailed but uninvolved written or oral instructions
Ability to deal with problems involving a few concrete variables in standardized situations
Typing 40+ words per minute
Effective problem solving, organizational and time management skills and ability to work in a fast-paced environment
Comprehend and analyze statistical reports
Preferred
Experience related to the Medicare Managed Care industry
Company
Alignment Health
Alignment Health provides eldercare services.
501-1000 employees
H1B Sponsorship
Alignment Health has a track record of offering H1B sponsorships. Please note that this does not
guarantee sponsorship for this specific role. Below presents additional info for your
reference. (Data Powered by US Department of Labor)
Distribution of Different Job Fields Receiving Sponsorship
Represents job field similar to this job
Trends of Total Sponsorships
2025 (3)
2024 (12)
2023 (17)
2022 (13)
2021 (11)
2020 (6)
Funding
Current Stage
Public CompanyTotal Funding
$696.05MKey Investors
K2 HealthVenturesWarburg PincusGeneral Atlantic
2024-11-15Post Ipo Debt· $321.05M
2024-01-09Private Equity
2021-03-26IPO
Leadership Team
Dawn Maroney
President, Markets & CEO of Alignment Health Plan
John Kao
CEO and Founder
Recent News
Alignment Healthcare USA, LLC
2025-10-31
Company data provided by crunchbase