• Conduct UM/CM audits in accordance with regulatory, contractual, and industry standards • Execute Utilization Management (UM) and Case Management (CM) audits using established methodologies, sampling criteria, and documentation standards to ensure accuracy, consistency, and regulatory readiness. • Evaluate delegated entities’ compliance with CMS and contractual requirements, and Alignment Healthcare’s UM/CM policies and standards. • Maintain organized, complete, and audit-ready documentation to support regulatory, accreditation, and internal oversight reviews. • Ensure all audit activities align with the enterprise audit strategy and risk-based approach established by the Manager, Audit Administration. • Engage delegated provider organizations to correct deficiencies and improve performance • Communicate audit scope, expectations, timelines, required documentation, and process steps clearly to delegated entities throughout the audit lifecycle. • Present audit findings to delegates, explaining root causes, performance gaps, non-compliance risks, and potential operational impacts related to UM/CM processes. • Support delegated entities in understanding UM/CM compliance requirements and expectations for corrective actions. • Foster professional, collaborative relationships to promote transparent discussions, accountability, and continuous improvement. • Perform risk assessment and prioritize UM/CM audits • Contribute to identifying high-risk areas by reviewing historical audit results, monitoring data, clinical performance trends, and operational challenges related to UM/CM. • Recommend prioritization of UM/CM audits based on severity of risk, regulatory sensitivity, and emerging compliance or clinical performance trends. • Provide input to refine audit scopes and schedules in alignment with the Manager’s risk-based UM/CM audit strategy. • Escalate emerging UM/CM-related risks, irregular findings, or potential systemic issues to the Manager for strategic review and future audit planning. • Validate corrective actions for UM/CM compliance • Review and validate Corrective Action Plans (CAPs) submitted by delegated entities to ensure remediation fully addresses UM/CM deficiencies identified during audits. • Assess evidence including revised workflows, updated clinical review criteria, policy changes, revised documentation, and utilization management decision processes. • Track CAP progress and ensure follow-up activities are completed, documented, and closed in accordance with departmental requirements. • Escalate irregular, stalled, or complex CAP issues to the Manager, Audit Administration for higher-level intervention. • Report UM/CM audit findings to facilitate organizational awareness • Prepare clear, concise, and well-structured audit summaries that highlight key risks, compliance gaps, operational issues, and improvement opportunities across UM/CM delegated functions. • Contribute to audit reporting tools, dashboards, and documentation used for internal leadership, cross-functional teams, and enterprise oversight groups. • Collaborate with Delegate Performance, Clinical Operations, Quality, Compliance, and other internal stakeholders to ensure findings are understood, actionable, and integrated into broader performance improvement efforts. • Support preparation of audit materials and evidence for internal committees, external regulatory bodies, and executive-level oversight forums. • Manage multiple UM/CM audits concurrently, ensuring adherence to established timelines, quality standards, and documentation requirements. • Monitor UM/CM operational, clinical, and compliance data to identify emerging issues requiring targeted audit review. • Support the development and delivery of training and education for delegated entities on UM/CM standards, audit expectations, and compliance requirements. • Assist in preparing documentation and evidence for CMS or other regulatory audits.

• Develops and implements strategic needs analyses and training plans for coding leadership • Coordinates and evaluates curriculum development and conducts the preparation and delivery of training for Medical Coders employed by Ensemble and providers that are contracted/employed and outlined in the client SOW • Provides guidance and leadership to coding and billing management in the implementation and administration of effective systems, processes, and procedures • Performs annual performance reviews and quality assurance reviews to assess comprehension of training efforts • Serves as a subject matter expert for professional fee coding for all involved personnel; ensures that information is accurate and current, meeting professional coding standards • Monitors and audits inpatient and outpatient accounts across the system • Assesses the educational needs of coding staff and providers and develops programs or researches educational resources to meet those needs • Assists with edits, denials and appeals, as well as training new and existing staff • Coordinates the presentation of ongoing professional seminars and materials via audio-conferences, webinars, and other publications • Provides reports of audit findings to coding management, individual coders and leadership as needed/requested

• Conduct rigorous Operations and Planning (O&P) assessments. • Execute comprehensive internal audits and gap analyses that mirror the strict technical rigor of Regional Entity enforcement. • Ensure that all reliability standards and internal controls are robust, fully documented, and operationally sound. • Lead on-site and off-site internal audits of registered entities to ensure strict adherence to NERC and regional O&P standards. • Review and assess potential violations, providing expert oversight on the development and filing of mitigation plans. • Perform deep-dive gap analyses and documentation reviews to identify and rectify compliance deficiencies. • Conduct Inherent Risk Assessments (IRA) and Internal Controls Evaluations (ICE) to facilitate high-level reliability assurance. • Provide technical guidance and instruction to registered entities and staff through workshops and compliance user group meetings. • Author and review program-level and plan-level documents, specifically regarding CIP, PRC-005, and O&P requirements.

Position Overview Globe Life AO is seeking motivated and reliable professionals to join our growing team as Remote Agent Supervisors. This fully remote role is ideal for individuals who are confident communicators, organized, and capable of supporting both clients and agents in a fast-paced, service-driven environment. As an Agent Supervisor, you will assist with client interactions, onboarding processes, and ongoing support while helping maintain performance standards and compliance. This role offers flexibility, structured training, and long-term growth opportunities within a mentorship-focused organization. What We Offer - 100% remote work environment - Comprehensive virtual training and ongoing development - Weekly pay with performance-based bonus opportunities - Union representation (OPEIU Local 277) - Company-provided life insurance with Accidental Death Benefits - Medical insurance reimbursement program - Modern technology and digital tools to support remote work - Leadership development events, conferences, and mentorship - Incentive programs, team recognition, and travel opportunities Key Responsibilities - Support the onboarding and enrollment of new clients - Provide professional, client-focused service and follow-up - Assist with the development and presentation of tailored benefit solutions - Respond promptly to client questions and service requests - Maintain accurate documentation and scheduling - Support outreach and relationship-building efforts - Ensure adherence to company policies, procedures, and regulatory standards Preferred Qualifications - Strong verbal and written communication skills - Excellent organization and time-management abilities - Ability to adapt quickly in a remote, fast-paced environment - Self-motivated with a strong sense of accountability - Comfortable working independently while contributing to a team - Professional demeanor and commitment to quality service Why Globe Life AO This role provides more than a paycheck—it offers a clear path for professional growth, leadership development, and long-term stability. Globe Life AO is committed to supporting its team members through training, mentorship, and a culture that values performance, integrity, and service. Apply Today If you are driven, dependable, and interested in building a remote career with advancement potential, we encourage you to apply and take the next step with Globe Life AO.