Cotiviti

Project Manager

• Lead the planning, execution, and successful delivery of complex, cross-functional, enterprise-wide projects with significant business impact, typically exceeding $500,000 per initiative.
• Manage projects involving multiple business units, functional areas, and stakeholder groups.
• Ensuring coordination of project objectives, deliverables, timelines, dependencies, and accountability across teams.
• Prepare and deliver regular project status updates, executive summaries, and key communications to Senior Executive Leadership, including progress against milestones, project health, risks, mitigation strategies, and escalated issues requiring leadership attention.
• Interface directly with various levels of organizational leadership, including executive sponsors, senior leaders, and functional management, to support project alignment, decision-making, and execution.
• Apply appropriate project management methodologies, tools, governance practices, and delivery approaches based on the scope, complexity, and requirements of each assigned initiative.
• Develop, maintain, and manage detailed project plans, timelines, milestones, action logs, RAID logs, governance materials, and other project-related documentation, while also providing concise executive-level summaries as needed.
• Facilitate effective communication, coordination, and collaboration across key functional areas, including but not limited to Sales & Client Engagement, Legal, Human Resources, Finance, Operations, Research & Development, Product Management, and Information Technology.
• Establish and maintain effective working relationships with internal stakeholders and cross-functional partners to support project execution, issue resolution, and organizational alignment.
• Partner with the Finance organization to monitor, track, validate, and report on the financial impact, cost savings, synergies, or business value associated with assigned initiatives.
• Collaborate with other Project Managers, Program Managers, and business leaders to manage project interdependencies, align timelines, and support enterprise-wide execution across related initiatives.
• Maintain current knowledge of project management principles, methodologies, tools, industry standards, and emerging best practices, and apply relevant improvements to project execution.
• Complete all responsibilities, objectives, and performance expectations as outlined in the annual goal plan.
• Perform additional duties, special projects, and other responsibilities as assigned.

Senior Project Manager – PMO

Medical Director

• Performs billing and coding audits to ensure charges are supported by the appropriate clinical documentation, review medical records, and document findings in Cotiviti and client systems as necessary.
• Conducts reviews of medical records, charges and associated documentation, researching and applying knowledge related to billing and coding guidelines searching for billing, coding and unsupported (or clinical) documentation in provider billing.
• Analyzes medical record documentation to determine the accuracy and completeness of clinical and coding information in support of correct claim coding and billing guidelines.
• Manages the workflow and deadlines to ensure accuracy and timeliness of audit results are consistent with client, federal, and state rules, regulations, and guidelines as applicable.
• Upholds HIPAA privacy and security guidelines.
• Conduct audit of appeals on claims originally recommended for changes by another CCV Auditor to uphold or overturn the original audit decision.
• Review new support evidence and/or documentation and gather other information as needed.
• Participate in client and provider meetings to review and discuss audit case findings and results.
• Assist the Clinical Audit Manager and Research Department to develop medical policy edits.
• Develop scorecards for existing rules-based logic to analyze trends in current rules-based audit selection criteria and recommend ongoing optimization.
• Participate in the design and implementation of the QA program and provide support for ongoing quality assurance audits for interrater reliability and coding accuracy.
• Support new sales activity and existing client growth by identifying value creation opportunities for our clients.

Medical Director, Clinical Chart Validation Team

Designer

• 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
• Coordinates and manages 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

Policy Design Specialist – Level I

Sales

• Develop, maintain, and deliver sales enablement content including playbooks, training modules, internal guides, messaging frameworks, and competitive resources.
• Partner with Sales Leadership to identify skill gaps and implement targeted training to improve sales performance and onboarding effectiveness.
• Support the creation and deployment of sales tools and assets such as battle cards, value messaging, pitch decks, and productivity insights.
• Collaborate with Marketing to align positioning, content, and tools with current campaigns, product launches, and brand standards.
• Facilitate ongoing training sessions including live workshops, virtual sessions, and self-paced learning.
• Analyze usage and effectiveness of enablement materials, providing recommendations for enhancement based on data and field feedback.
• Maintain and optimize the organization of enablement materials to ensure easy access and adoption across the Sales team.
• Support the execution of Sales onboarding programs, ensuring new hires ramp quickly and effectively.

Sales Readiness and Enablement Manager

Solutions Engineer

• Partner with Sales on strategic opportunities involving quality measurement and Star Ratings solutions.
• Lead product demonstrations showcasing HEDIS performance analytics, care gap identification, and quality improvement capabilities.
• Present to health plan quality directors, Star Ratings teams, and executive leadership.
• Conduct discovery sessions to understand customer quality challenges, current performance, and improvement goals.
• Support pilot and proof-of-concept initiatives to demonstrate solution value.
• Develop technical content for quality and HEDIS-focused RFP responses.
• Articulate how Cotiviti's solutions address NCQA HEDIS certification requirements.
• Present solutions during finalist presentations with focus on quality improvement outcomes.
• Support implementation scoping and level-of-effort estimates for complex engagements.
• Capture customer feedback on product capabilities, gaps, and enhancement priorities.
• Maintain deep expertise in NCQA HEDIS measures, specifications, and reporting requirements.
• Develop and deliver training for Sales teams on quality measurement fundamentals.

Senior Solutions Consultant – HEDIS, Quality Solutions

Full-stack Engineer

• Build and enhance production-grade software applications using AI-assisted development workflows
• Translate product and technical requirements into working, maintainable software
• Use AI tools to accelerate coding, debugging, testing, refactoring, and documentation
• Review, validate, and refine AI-generated code to ensure correctness, performance, security, and maintainability
• Design and implement clean, well-structured APIs, services, and application components
• Contribute to scalable backend systems and full-stack solutions as required by the team
• Apply sound engineering judgment to balance speed, quality, and long-term maintainability
• Participate in design discussions and technical reviews within the team
• Orchestrate the effective use of AI tools across development activities
• Collaborate closely with the AI-Native Tech Lead to implement architectural and engineering best practices
• Work effectively within a small AI-Native team to deliver features end-to-end

Senior Software Engineer, AI Orchestrator

Business Operations

• Leads consultative requirements gathering sessions with internal operational stakeholders to scope analytical support needs and provide solutions that empower data driven decision making and revenue growth.
• Conducts sophisticated data analysis, modeling, prescriptive/diagnostic insight generation and data storytelling across all facets of the Clinical Chart Validation (CCV) business.
• Subject-matter expert in understanding database schema across all company data servers.
• Works with data scientists/engineers on deployment of software solutions through planning, testing, and QA efforts.
• Leads process optimization exercises to compress the time-to-value in reporting/production and charged with maximizing the utility of individuals across the organization.
• Creates intuitive automated business tools, templates, and KPI reporting products that allow departments (operations/yield) to work effectively.
• Designs data models and creates complex tools for internal team use that can be purposed for a broad range of trend analysis.
• Conducts ROI and opportunity cost evaluations for the reallocation of resources, capital investments, and sizing new business opportunities for account management teams.
• Assists management in transformational execution of new business practices and in driving operational accountability/rigor.
• Leads monthly/quarterly business reviews that benchmarks each CCV departments trending financial performance, evaluates cost, and measures the overall productivity/health of the business.
• Collaborates cross functionally with other internal departments to solve key business challenges and contributes as needed in executing solutions.
• When necessary, creates, delivers, and maintains basic client/internal reporting.
• Owns strategic initiative projects that directly impact in-year revenue.
• Trains and mentors other analysts on best practices.
• Self sufficient with minimal direction needed.

Principal Business Operations Analyst

• Prospect and qualify new sales leads to expand the customer base.
• Present and demonstrate the value of products or services to prospective buyers.
• Build and maintain relationships with clients and potential clients.
• Understand customer needs and develop tailored proposals and solutions.
• Negotiate contract terms with clients and communicate terms to stakeholders.
• Collaborate with sales teams to maximize profit by up-selling or cross-selling.
• Manage a portfolio of accounts and operate as the lead point of contact for all matters specific to those accounts.
• Track, analyze, and communicate key quantitative metrics and business trends to management and clients.
• Own the sales process, helping the organization understand the customer, and coordinating with other team members to ensure the timely and successful delivery of solutions.
• Keep up-to-date with market trends, product innovations, and competitor actions.
• Must be willing to travel as needed (up to 50%) to support field based sales activities, including in person customer meetings and contract negotiations conducted away from the employer’s place of business.

Regional Sales VP

IT Support

• efficiently and professionally handle daily administrative activities within the COB and DM departments to assist the audit to meet and exceed client expectations.
• work under the direct supervision of a Team Lead and/or Manager, providing a valuable learning experience and growth opportunities.
• Collaborates with all levels and members of the COB & DM auditing team to provide diverse support and task-based assignments, contributing to the achievement of business objectives and goals for the calendar year.
• Communicates directly with Medicare, Insurance companies, Providers, and/or Employer groups to obtain pertinent member eligibility details that will impact the correct order of member liability.
• Enters accurate member, group, and claim information into Cotiviti tools (Recovery Management Systems, SharePoint, COB Tracker, Client Systems).
• Ensures confidentiality and security of all data, adhering to all HIPAA (Health Insurance Portability and Accountability) laws and requirements.
• Demonstrates the skills, knowledge, and ability to ensure that our environment is a safe one, complying with industry standards.
• Demonstrates understanding of Cotiviti policies & procedures, and external regulatory requirements and performs duties in accordance with such regulatory requirements.
• Meet or exceeds standards for productivity and quality as identified by guidelines as set forth by the Team Lead and/or Manager.

Audit Support, COB, DM

• Development for applications used by external and internal customers using Java, Angular and PL/SQL, and other related technologies.
• Contribute using their Healthcare domain expertise to core applications to solve complex problems.
• Work with Product owner and other team members to develop software using Scrum methodology.
• Participate in peer reviews.
• Build and support delivery of code by following Cotiviti processes.
• Build quality code.
• Help improve code quality and maintainability of existing code while continuing to meet challenging deadlines for business delivery.

Senior Software Engineer

Product Manager

• empathize with our lines of business and identify clear objectives to formulate the problem
• Work backwards from our customers to create a compelling product vision and a product strategy to solve complex business problems
• Own the AI product roadmap and prioritize features to ensure your MVPs quickly add value
• Manage the lifecycle of AI products and work independently with engineers, scientists, doctors/nurses and other stakeholders on defining, building, and delivering the right products
• You are data driven and influence our business strategy and technical priorities with that vision
• Keep all your stakeholders up to date on your products and capabilities roadmap
• Independently represent the products and the team, and are comfortable communicating with executives as well as with business and technical stakeholders
• Dive deep with business lines to identify and understand the and think big to build scalable products
• Use data driven methods to understanding and test assumptions
• Deliver products on time with the right feature set and high quality
• Evangelize our AI products and drive adoption
• Think through all aspects of your products' life cycles, incl. business, technical, legal, and marketing
• Create a healthy and cohesive learn it all culture that binds all aspects of product
• Work with key stakeholders within Research and Development as well as Operations, along with product management to assess the potential value and risks associated with business problems that have the potential to be solved using machine learning and Artificial Intelligence techniques
• Work with production operations to deploy your model into production and support them in monitoring model performance
• Participate in other data science teams collaborating with your peers to support their projects
• Participate in knowledge sharing sessions to bring new insights and technologies to the team
• Participate in design sessions to continuously develop and improve the Cotiviti machine learning platform
• Provide End to End value-based solutions, including data pipeline, model creation and application for end user consumption

Artificial Intelligence Product Manager

Technical Program Manager

• Responsible for working cross functionally to coordinate development efforts that involve multiple products or integration points between products.
• Develop detailed Program delivery Roadmaps with input from Scrum Masters, project management, delivery managers, implementations and migrations teams.
• Align scope and timeline with Release Train Engineers, Business Owners and Solution Architecture by engaging in Agile Release Train events including PI Planning and Epic Sync.
• Monitor overall progress and initiate corrective action, as appropriate, to ensure that program goals are met.
• Execution of project planning activities to include determination of scope, milestones, risks, and issues.
• Promptly escalate risks to appropriate leadership and stakeholders.
• Create, maintain, and disseminate reports on program-to-program steering committee and other key stakeholders.
• Develop appropriate practices for the program including right sizing meeting schedules and content.
• Work across the organization with functional managers to determine and satisfy program needs.
• Support process improvements within the organization delivery processes.
• Collaborate with the requirements Project Manager to develop delivery plans, and manage requirement changes throughout incremental delivery.
• Collaborate with Implementations, Migrations, and other business teams to facilitate software adoption by removing obstacles and sharing user feedback.
• Communicate adoption progress to key stakeholders.
• Maintain relationships and alignment with key program stakeholders to achieve program goals.
• Analyze data to understand current solution performance and discover future opportunities.
• Drive the programs across the AI/ML model lifecycle from intake and risk assessment through development, validation, deployment, and monitoring.
• Establish mechanisms that bring clarity, reduce model risk, and accelerate value delivery, including model inventory/registry, documentation standards, evaluation frameworks, fairness and explainability practices, change management, and ongoing monitoring.
• Complete all responsibilities as outlined in the annual performance review and/or goal setting .
• Complete all special projects and other duties as assigned.

Senior Technical Program Manager – Model Risk, Responsible AI

Auditor

• Utilize retail experience to perform audit procedures, identifying and defining issues.
• Identify and validate over and under-payments of claims.
• Enter claims into Cotiviti's system accurately in accordance with standard procedures.
• Update current reports, develop and run custom queries, and validate report accuracy.
• Provide verification of claims validation in a concise written manner.

Auditor II, Retail

Data Engineer

• Create, maintain and execute intermediate to advanced Spark scripts for data management and data validation, and data integration.
• Create, maintain and execute basic to intermediate SQL scripts for data management and data validation.
• Optimize the queries to improve the efficiency of daily tasks.
• Perform data analysis and identify any issues.
• Work with other groups such as Engineering team, DBA, Cloud ops, etc. to troubleshoot and resolve any environmental or network issues that impact your work.
• Extend your support to after – hours or weekends as needed.
• Create and maintain data pipelines as needed.
• Validates the tasks results to ensure that all the requirements are met.
• Adhere to all the industry level and organization level compliance rules and regulations to maintain data integrity.
• Complete individual productivity tracking.
• Complete task assignments using department ticketing system within assigned deadline.
• Achieve organizational and individual goals as identified in performance reviews and goal setting exercises.
• Complete all special projects and other duties as assigned.

Data Engineer – AI, Spark, Databricks, Healthcare

Executive Assistant

• Manage complex calendars, coordinate meetings, and prioritize scheduling to align with the CEO’s goals
• Handle all aspects of travel planning, including itineraries, logistics, and expense reporting
• Prepare, edit, and format documents, presentations, board materials, and executive communications
• Conduct research, summarize insights, and provide briefing materials prior to meetings and events
• Monitor email and information flow, triaging and responding on behalf of the CEO when appropriate
• Act as a thought partner to help the CEO focus on the highest‑impact priorities
• Support leadership team coordination, including meeting agendas, follow-ups, and action‑item tracking
• Assist in preparing for key business reviews, presentations, external events, and stakeholder meetings
• Identify issues, anticipate challenges, and recommend solutions to keep operations running smoothly
• Serve as a primary point of contact between the CEO and internal/external stakeholders
• Uphold confidentiality and discretion in handling sensitive company and personnel information
• Draft correspondence, talking points, and CEO messages as needed
• Build strong internal relationships across all levels of the organization
• Develop and maintain systems, processes, and tools that improve efficiency for the CEO’s office
• Coordinate special projects, cross-functional initiatives, and ad hoc requests
• Support board governance processes, including materials preparation and logistics
• Ensure deadlines are met and follow through on commitments made by the CEO