Policy Design Specialist I

Cotiviti

Policy Design Specialist responsible for managing health plan clients and executing project requests at Cotiviti. Implementing and updating medical policies per client requirements and industry standards.

Posted 7/9/2026full-timeRemote • 🇺🇸 United StatesJunior💰 $23 - $25 per hourWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in policy implementation and client configuration management within the healthcare sector, ensuring compliance with industry standards and client expectations. Proficient in analyzing claim data and maintaining high accuracy in project deliverables while providing exceptional customer service.

Highest-signal resume keywords

Policy ImplementationClaim Payment/Adjudication ExperienceMedical Terminology KnowledgeSQL ProficiencyAnalytical Problem-Solving Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Policy DesignProject ManagementQuality AssuranceData AnalysisMedical Payment PolicyHealthcare AdministrationClient ConfigurationAnatomy and Physiology KnowledgeMicrosoft Office SuitePeer Review

Soft Skills

Effective CommunicationTeam CollaborationTime ManagementCustomer Service OrientationAdaptability

Certifications & Qualifications

RHIACPC

Industry Keywords

HealthcareHealth Plan Payment PolicyMultispecialty ExperienceClient PresentationsQuality Targets

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Implement new policies and update existing policies for clients to ensure the policy is editing in accordance with the industry and per the client’s expectation
Write and design client requested policies from scratch, translating client expectations into Cotiviti guidelines to ensure appropriate configuration
Execute projects requests, design work orders, and actively monitor queues to ensure all requests are completed by the desired completion date
Balance multiple priorities and manage projects deliverables for two or more healthcare clients
Proactively assist on other client accounts where needed
Provide the highest level of customer service by documenting and staying current regarding all client sensitivities and configuration needs
Investigate situations where configuration updates conflict with client customizations or needs
Meet daily and monthly production and quality targets; maintaining an exemplary level of accuracy in all work; ensuring that the capture and completion of assigned projects are audited and that corrections are made where needed
Perform regular quality checks to ensure accuracy for all a client’s policy set by analyzing quality reports and troubleshoot results, determining root cause(s) and promptly resolving
Perform Peer Review responsibilities by providing feedback to peers assisting in achieving department quality goals
Receive peer feedback, identifying any trends and proposing concise solutions to minimize error rate
Resolve testing issues and conflicts related to policy configuration updates and policy overlaps
Analyze pre and post client claim data to ensure appropriate claim editing
Participate in client presentations by providing configuration expertise and capturing client decisions
Coordinate and manage post-client presentation activities
Maintain detailed and up to date knowledge of internal applications, actively participating in all trainings and software release meetings
Communicate effectively and timely with upstream functional areas to resolve issues

Requirements

What you’ll need

Bachelor's Degree preferred or equivalent work experience
Coding or HIM credential preferred (RHIA, CPC, etc.)
1 or more years of experience / understanding of: medical terminology, anatomy and physiology
Health plan payment policy experience or internal company payment policy experience
2 or more years of experience in claim payment/adjudication, medical payment policy, experience in hospital administration, or multispecialty experience and exposure to professional and facility claims (or equivalent Cotiviti experience)
Proficient with Microsoft Office Suite (Word, Excel, Power Point)
Experience with SQL preferred
Ability to work well in a team environment or independently and perform well under pressure
Strong analytical and problem-solving skills
Excellent verbal and written communication skills.

Benefits

Comp & perks

medical, dental, vision, disability, and life insurance coverage
401(k) savings plans
paid family leave
9 paid holidays per year
17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti