Cotiviti

Analyst

• Support the enhancement and ongoing optimization of claim selection processes and tools.
• Apply deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies.
• Contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes.
• Provide coding guidance, analytical insights, and validation to inform model development, tuning, and output evaluation.
• Analyze selection outputs and take meaningful action based on audit performance trends.

Concept Development Analyst – Automated Concepts

Auditor

• Performs clinical quality assurance review of daily clinical validation reviews
• Responsible for communicating with the initial auditor on differing decisions
• Integrates healthcare auditing principles and uses objectivity in performance of medical audit activities and review
• Utilizes industry knowledge and proficiency in healthcare to substantiate decisions
• Performs work independently and reviews work of others
• Reviews medical records and applies in-depth knowledge of clinical criteria to determine medical necessity

Senior Auditor Quality – OPSP

Director

• The Product Management Director will lead a cross-sectional, matrixed team in implementing and overseeing a customer- and sales-driven approach to building and launching new features, capabilities and offerings into the marketplace
• Leverages subject matter expertise to provide input into Cotiviti’s strategic plan for client-facing platforms; collaborates with executive leadership to develop and track financial and non-financial success measurements
• Work with Marketing, Product Strategy and GTM teams to understand market needs for Analytics solutions
• Perform detailed product and content analysis to support exploration, evaluation and development of new solutions
• Ensure new analytics capabilities and solutions meet business and product requirements
• Establish overall Go-to-Market strategy for all products within the strategic solutions set

Product Director

Implementation Specialist

• Lead and manage the implementation and operation team in day-to-day activities
• Partner with internal product development, operations, and client services groups to ensure engagement
• Look for process improvement opportunities and provide necessary feedback
• Mentor staff to maximize performance and potential
• Handle remote project collaboration to execute milestones/tasks

Implementation Manager

Product Manager

• Develop, maintain, and execute the product roadmap, prioritizing features and enhancements that align with business objectives and client needs.
• Develop and own product strategy and roadmaps for Artificial Intelligence (AI), Machine Learning (ML), and Business Intelligence (BI) solutions that accelerate growth and inform strategic decisions.
• Lead projects through the full product lifecycle, from ideation and requirements gathering to development, launch, and ongoing optimization.
• Gather and synthesize feedback from stakeholders, translating insights into actionable improvements for the platform.
• Partner with clients to understand needs, develop analytic solutions, and communicate insights that drive strategic decisions and maximize client value.
• Collaborate with data scientists, data engineers, BI developers, data analysts, and business stakeholders to define requirements and deliver analytic products.
• Advise stakeholders and end-users on the best use of analytics to address business challenges and achieve desired outcomes.
• Prioritize product features and enhancements to maximize business value, technical feasibility, and user needs.
• Design and oversee product experiments and validation processes to ensure analytics solutions meet performance and accuracy benchmarks.
• Monitor product metrics and leverage data-driven insights to inform decisions, improve features, and enhance user experience.
• Communicate platform status, progress, and vision to leadership and executive teams through regular presentations and reports.
• Provide monthly updates on platform performance, enhancements, and client impact.
• Champion intuitive user experiences by working closely with BI developers to translate analytics into actionable and easy-to-understand insights.
• Evangelize data analytics products across the organization and with external clients, providing education and supporting adoption.
• Translate data-driven insights into thought leadership through white papers, blog posts, and conference presentations, establishing the company’s position as an industry leader.
• Partner with upstream and downstream organizations that consume data from the RVA platform to ensure seamless integration and alignment.
• Serve as the initial escalation point for resolving issues related to the platform, coordinating swift and effective solutions.
• Support the rollout of new platform versions, including launch planning, change management, and user adoption activities.
• Lead the integration of additional products into the RVA platform, collaborating with technical and business teams to expand platform value.
• Provide strategic guidance to resources delivering adhoc analyses requested by customers; identify opportunities to productize or scale recurring adhoc requests.
• Foster a culture of innovation, continuous improvement, and client-centricity within the product team.
• Stay current with emerging data analytics, machine learning, and technology trends, integrating new developments into product strategy where appropriate.
• Ensure product documentation is accurate, accessible, and up-to-date for all stakeholders.
• Monitor compliance with relevant data privacy, security, and regulatory requirements.

Analytics Product Manager

Artificial Intelligence

• Play a key role in driving the planning and roadmap for our AI Solutions across lines of business
• Manage and drive critical AI programs end to end
• Define product strategy, roadmap and product requirements for our AI Platform and solutions
• Drive executive decision making for new investments, including competitive analysis, program goals and business requirements, architectural concepts, risk management, financial analysis, schedule and strategy
• Coordinate and partner closely with Data Science, Engineering, finance, legal and other stakeholders
• Develop and drive end to end program management to define, prioritize, and implement features, infrastructure, processes, and workflows
• Drive technical projects from requirements including managing complex project schedules, removing roadblocks, and keeping processes running smoothly
• Identify and prioritize customer needs, market opportunities, and competitive gaps, and translate them into clear and actionable product requirements and specifications
• Develop and maintain a high level of technical proficiency in AI
• Operate effectively in ambiguity
• Apply process where it creates value, and design process where it’s needed
• Work closely with operations teams and drive adoption across the portfolio
• Establish trusting relationships with different stakeholders and create avenues to synergically improve the AI landscape of the company
• Hire, develop, coach, lead and retain top-tier talent

Director, AI Product Management

Client Services Representative

• Responsible for coordinating the cross-functional client team focused on achieving plans with clients, revenue retention, and client satisfaction and growth for the Prospective Payment PPM and CV products
• Serves as both internal and external client liaison accountable for triaging, managing, monitoring and support of client related activity
• Builds and sustains client relationships, achieves the client’s recognition of Cotiviti as a partner
• Ensures client success with Cotiviti PPM/CV products through understanding client's needs and unique business situations
• Identifying solutions, proactively identifying potential issues that could impair success
• Serves as the primary client contact and trusted advisor for client operational representatives
• Establishes and cultivates relationships with client contacts to identify needs that result in expanded opportunities or solutions
• Collaborates with the Go-To-Market team on client strategic plan and leads tactical execution
• Promotes policy adoption and acceleration to increase client value through organization, communication, and project management within internal and external teams
• Identifies and communicates cross product opportunities
• Manages the operational implementation and execution of client payment policy decisions by collaborating with client operations managers across multiple departments
• Coordinates and manages joint meetings with client and internal staff including scheduling, facilitation, meeting agenda and material preparation/coordination, meeting minutes/action item tracking, and meeting logistics
• Documents and distributes meeting minutes, action items and follows-up on action items to ensure satisfactory and timely completion
• Posts and maintains accurate, up-to-date client documentation in Cotiviti’s library
• Manages the internal and external aspects of all client initiatives and joint projects to ensure objectives are met and the team is progressing toward goals
• Monitors program performance, analyzes monthly performance reports, and drafts observations providing insight on trends for client consumption
• Identifies and performs root cause analysis to make recommendations and develops and executes on action plans to remedy interface related issues
• Provides client testing support to ensure success with all operational and policy aspects of initiatives
• Manages all client inquiries, ensuring entry into the appropriate application and ensures timely execution of resolution

Client Services Manager

• Ensures adequate support for the client-facing team on coding and policy as well as operational related activities.
• Supports Medical Policy Directors (MPD) through various aspects of the New Policy processes.
• Marks policies provided by the MPD to ready to present in CPW.
• Generates New Policy Presentations, the associated decision matrices, and pulls all Business Objects (BO), Tableau and/or BI and Presentation Manager (PM) reports.
• Ensures policies selected for presentation include all appropriate claim types and LOB.
• Submits a request to Medicaid Research for conflict review when appropriate.
• Assists in formatting New Policy Presentation documents for client presentation.
• Performs multi-faceted data and report analytics.
• Analyzes the report output and provides accurate client or policy information based on thorough report analytics.
• Generates, modifies, and formats Web Intelligence (Webi) reports for ad hoc purposes.

Client Service Analyst – PPM

Data Engineer

• Oversee ETL processes to ensure their success, with the primary responsibility of providing accurate and timely data across various products to support the company's revenue generation.
• Maintain data pipelines running on proprietary big data processing platform and providing support to make sure data delivery SLAs are met.
• Maintain data engineering processes using a variety of tools including T-SQL, Spark and Scala, and shell scripting.
• Generally focused on data ingestion for healthcare data management, data validation, statistical report generation, and program validation.
• Develop, support, and improve scalable and efficient data ingestion processes and techniques aimed at enhancing process efficiencies and optimizing query performance for our proprietary data applications and systems.
• Implement and perform data validation and quality checks to maintain high data integrity.
• Perform troubleshooting, data analysis, data mining, investigations and identifying root cause of issues using several cutting-edge data analysis tools in a fast-paced environment.
• Collaborate with stakeholders to understand data requirements and deliver high-quality data solutions.
• Work with Technical Operations to troubleshoot complex database issues related to the entire environment including OS, storage, and servers.
• Provide off hours support to resolve production issues when necessary.
• Develop data transformation specifications to convert source data to be loaded into target data warehouse tables using SQL and other Data Integration/ETL tools.
• Support the implementation of data governance policies and security measures to protect sensitive information.
• Create and maintain dashboards as needed.
• Participate in meetings with clients and/or stakeholders.
• 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.
• Must be able to perform duties with or without reasonable accommodation.

AI Research Scientist

• Conducts primary and secondary research of advanced and emerging healthcare informatics technology with a focus on Generative AI and emerging Artificial General Intelligence technology for healthcare treatment, payment, and operations use cases.
• Creates research papers, analytical reports, proposals, and educational material.
• Maintains a deep understanding of technology trends and hands-on experience with relevant technologies.
• Develops generative AI models, architectures, databases, and systems to improve healthcare solutions.
• Assists in developing and improving LLMs and ML tools used across the organization.
• Communicates technology-related updates and requirements to other departments and contributes to presentations for senior management.
• Collaborates with research and development teams, product management, and strategic analysts to support ongoing projects.
• Partners with Business Units to provide reliable intelligence, validated technology options, and insights on enterprise and industry trends.

Intern – Generative AI Research Engineer

Operations

• Represent the business unit and operations by defining operational requirements that enable scalable, efficient, and high-quality delivery
• Respond promptly to Payment Requests for Information and Requests for Proposals
• Support client intake requests for the PrePayment business unit by understanding client requirements and providing tailored solutions and cost estimates
• Hire, develop, coach, lead, and retain top-tier talent, fostering a team and culture dedicated to implementing best-in-class practices that drive superior internal and external customer satisfaction
• Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth
• Collaborate with key partners to ensure operational excellence
• Sponsor, lead and support operational improvement initiatives related to people, processes, and technology to deliver incremental value, enhance operational efficiency, and meet or exceed service and quality goals
• Develop lean business cases, establish key performance indicators, and create requirements and test plans for business improvement initiatives
• Communicate business unit performance and improvement initiatives to relevant stakeholders
• Enforce Cotiviti’s intellectual property protection best practices
• Ensure clinical operations comply with regulatory, accreditation, corporate, and client requirements
• Diagnose and resolve issues, prepare schedules, and set deadlines to ensure timely completion of work
• Develop short-term and long-term plans to anticipate client needs and drive operational improvements
• Foster a positive culture that supports corporate goals, encourages initiative, and promotes open communication across all levels of the organization
• Work closely with and support business leaders throughout the organization
• Establish and maintain effective client and team dynamics in a highly collaborative manner
• Manage and delegate team and individual projects and assignments
• Review performance against operating plans and standards
• Provide reports and metrics to drive continuous operational quality
• Cultivate and maintain personal relationships with executive leadership
• Complete all responsibilities as outlined in the annual Performance Plan
• Complete all special projects and other duties as assigned

Senior Director, Payment Integrity Operations

• Identify, frame, and refine high-value innovation opportunities across healthcare solution domains, including payer, provider, life science, and patient-facing markets
• Support Project Vanguard by shaping solution pathways for Validiti 2.0 and Validiti 3.0 diversification into adjacent and new healthcare markets
• Translate emerging technology capabilities into operationally credible, economically coherent, and commercially meaningful business narratives
• Bridge across business-unit leaders, product stakeholders, healthcare subject matter experts, researchers, architects, AI specialists, and solution builders to shape feasible innovation directions
• Work across lines of business to identify linked solution value, cross-business-unit leverage, and broader platform or ecosystem opportunities
• Help define solution opportunities that reduce friction between payers and providers and better leverage Cotiviti's position across the healthcare ecosystem
• Ensure innovation concepts are grounded in healthcare operational realities, including workflow design, reimbursement dynamics, adoption barriers, staffing constraints, and business economics
• Partner with healthcare technology research, advanced AI research, architecture, and solution innovation development leaders to shape opportunities into actionable solution directions
• Develop future-facing solution hypotheses informed by healthcare market evolution, workflow change, and enabling technology
• Communicate and evangelize innovation opportunities clearly and credibly to executive and functional stakeholders, including building support for opportunities not yet widely understood
• Support evaluation of internal development, partnership, and ecosystem pathways for new solution innovation
• Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction
• Complete all responsibilities as outlined in the annual performance review and/or goal setting
• Complete all special projects and other duties as assigned

Director, Solution Innovation Strategy

Account Manager

• Work closely with business leaders to develop and drive contracting strategies
• Draft, review, and negotiate strategic partnership agreements and related transaction documents
• Play a lead role in advising internal stakeholders on contract interpretation
• Maintain contract databases and tracking systems for vendor and strategic partner relationships
• Prepare legal summaries and risk assessments on contract terms and key provisions

Senior Counsel – Partnerships

Sales

• Own and execute a new sales strategy for Cotiviti’s Pharmacy Claim Editing and Accuracy solutions within an assigned territory
• Prospect, qualify, and close new opportunities with health plans, payer-owned PBMs, Third-Party Administrators (TPAs), and self-funded plan administrators, including organizations supporting Medicare Part D, Medicaid, commercial, and ASO lines of business.
• Develop and maintain senior-level relationships with: Health Plan and TPA Executives (President, GM, EVP) Pharmacy Operations, Claims, and Payment Integrity Leadership Medicare Part D compliance, STARS, and regulatory affairs leaders Finance, Network Management, and Policy leaders Procurement and Strategic Sourcing teams Self-funded plan sponsors and their benefits consultants/advisors (e.g., Mercer, WTW, Aon)
• Lead complex, multi-stakeholder sales cycles involving: Pharmacy claim accuracy and payment integrity use cases ROI, savings validation, and performance guarantees Software + services contracting models
• Develop territory and account plans aligned to pharmacy market dynamics, customer priorities, and competitive landscape.
• Collaborate with internal teams (Product, Clinical Pharmacy SMEs, Legal, Implementation) to: Shape solution positioning and executive-level business case development Support RFPs and procurement processes Deliver compelling value propositions
• Monitor competitive activity, pricing trends, and market conditions specific to pharmacy claim accuracy and claims auditing.
• Represent Cotiviti at pharmacy related conferences, industry forums, and executive briefings.
• Maintain accurate pipeline management, forecasting, and opportunity tracking within Cotiviti’s CRM.
• Provide regular updates to sales leadership on: Pipeline health (sufficiency and velocity) Forecast risk Market intelligence and customer feedback
• Ensure all sales activities align with Cotiviti policies, compliance standards, and contracting guidelines.
• Complete all responsibilities outlined in the annual Performance Plan and other duties as assigned.

Sales VP, Pharmacy Claim Editing Solutions

• Oversee and drive quality performance across payment integrity solutions, ensuring continuous improvement and operational excellence
• Collaborate with cross-functional business units to measure, report, and enhance quality performance metrics and outcomes
• Develop and align best-in-class quality processes and standards, delivering exceptional results through operational excellence
• Work closely with Operations and Product teams to drive quality improvements by leveraging technology, optimizing processes, and developing talent
• Ensure timely and accurate responses for Payment Requests for Information (RFIs) and Request for Proposals (RFPs)
• Support client intake requests for PrePayment Business Unit by understanding client requirements and providing tailored solutions and cost estimates
• Hire, develop, coach, and retain top-tier talent, fostering a culture dedicated to exceptional quality and customer satisfaction
• Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth
• Lead and support operational improvement initiatives encompassing people, processes, and technology to deliver incremental value and operational efficiency, consistently meeting or exceeding service and quality goals
• Enforce Cotiviti’s intellectual property protection best practices throughout all operations
• Diagnose and resolve issues proactively, manage schedules, and ensure deadlines are met for timely completion of work
• Develop short-term and long-term plans to anticipate client needs and operational improvements
• Cultivate a positive workplace culture that supports corporate goals, promotes initiative, and fosters open communication at all organizational levels
• Collaborate and support business leaders throughout the organization, maintaining highly effective client and team dynamics in a collaborative environment
• Manage and delegate team and individual projects/assignments, and review performance against operating plans and standards
• Provide comprehensive reports and metrics to drive operational quality and inform strategic decisions, based on operational objectives and work plans at a senior level
• Build, maintain and influence strong relationships with executive leadership to support organizational goals