Research, analyze, and quality-check new and existing medical policies, translating industry references and coding expertise into payment policy rules and enhancements. Collaborate with developers, architects, product and go-to-market teams, and internal operations to guide rule development, analyze data, and support policy rollouts across multiple payment policy solutions.
Review and determine appeals for healthcare claims by analyzing medical records, coding, coverage policies, and provider-submitted documentation, then prepare clear, evidence-supported responses. Research Medicare contractor disputes and support escalated and ALJ cases while meeting quality and productivity standards and identifying process improvements.
The role involves handling daily administrative activities for the Coordination of Benefits and Data Mining departments to support audit objectives. Responsibilities include communicating with Medicare, insurance companies, and providers to verify eligibility and accurately entering data into company systems.
The Sales VP is responsible for driving new business sales within the healthcare payer market by managing a territory and implementing effective sales strategies. They will build relationships with executive-level stakeholders and ensure sales activities align with company goals and budget constraints.
The Senior Director of Product Management defines the vision, strategy, and roadmap for the Consumer Engagement product portfolio while leading and mentoring a high-performing team. They collaborate cross-functionally to drive product innovation, manage the end-to-end lifecycle, and ensure alignment with company business objectives.
The Senior Solutions Consultant acts as a subject matter expert to drive risk adjustment strategies, supporting sales teams with demonstrations, RFP responses, and solution design. They also monitor market trends and provide critical feedback to product teams to enhance solution offerings.
The Senior Financial Analyst will lead financial forecasting, budgeting, and analysis models while providing reporting support to business unit leaders. They will also act as the primary point of contact for FP&A deliveries and ensure accurate variance analysis against budgets and benchmarks.
The Payment Accuracy Specialist is responsible for auditing client data to identify and recover over-underpayment claims while ensuring compliance with regulations. They document findings, communicate audit recommendations, and maintain production goals within the Data Mining Business Unit.
The Product Manager will lead the development and optimization of payment integrity products by defining requirements and collaborating with software teams. They will also manage product positioning, perform client demos, and drive initiatives from concept to implementation.
Perform daily audits on provider appeals to ensure coding accuracy and reimbursement appropriateness based on guidelines. Collaborate with team members and quality assurance staff to clarify coding results and facilitate continuous process improvement.
The Client Policy Manager is responsible for maintaining the integrity and accuracy of client medical payment policies through research, analysis, and coordination with internal and external stakeholders. They act as a liaison to ensure policies are up-to-date, compliant with industry standards, and effectively communicated to the client.
The Senior Revenue Integrity Analyst manages month-end revenue validation controls, investigates revenue leakage, and oversees inventory reconciliation. The role also develops actionable reporting, mentors junior analysts, and partners with cross-functional teams to resolve complex invoicing and financial discrepancies.
The Senior Software Engineer will support and enhance existing software applications within the Cotiviti product suite. They will collaborate with cross-functional teams to analyze issues, implement performance improvements, and mentor other developers.
The AI Security Architect designs and implements security frameworks to protect AI systems from adversarial attacks and data breaches. They collaborate with cross-functional teams to integrate security measures throughout the AI development lifecycle and ensure regulatory compliance.
The Senior Investigator identifies, investigates, and evaluates suspected healthcare fraud, waste, and abuse using data analytics and claims review. They also report findings, conduct training, and support legal proceedings as necessary.
The Project Manager owns the end-to-end delivery of projects, ensuring plans are realistic and stakeholders are aligned. They are responsible for managing project artifacts, facilitating team meetings, and proactively handling risks and issues.
The Data Engineer will manage data implementations, production, quality, and security while executing SQL scripts for data validation. They will also collaborate with engineering teams to troubleshoot environmental issues and maintain operational dashboards.
The Senior Director of Government Programs oversees the P&L, operational delivery, and strategic growth of key government contracts. This role involves managing staff, ensuring contract compliance, and building strong relationships with internal and external stakeholders.
The Product Manager is responsible for defining and executing product strategy, roadmaps, and requirements while managing clinical and claims data. They lead cross-functional teams to ensure successful product launches and alignment with business objectives and customer needs.
The auditor is responsible for performing clinical chart validation and coding audits for outpatient and specialty claims to ensure accuracy and medical necessity. They will interpret medical records, document audit results, and identify opportunities for process improvements or claim recoveries.
The Revenue Cycle Specialist is responsible for the accurate reconciliation and posting of payments, ensuring system alignment, and managing financial data. They also conduct research to resolve payment discrepancies and ensure compliance with recovery laws and state regulations.
The Team Lead is responsible for the daily oversight, training, and development of Revenue Cycle Specialists while ensuring operational controls and process adherence. They also analyze revenue streams to optimize financial performance and serve as an escalation point for complex client inquiries.
The Director of Product Management is responsible for developing and executing product strategy for value-based payments while leading a team of product managers. This role involves cross-functional collaboration to drive innovation, product commercialization, and revenue growth within the healthcare sector.
The VP of Product, Interoperability will own the market strategy, product roadmap, and commercial growth for health plan interoperability solutions. They will lead a matrixed team to deliver next-generation payer/provider collaboration tools while ensuring alignment with regulatory standards and corporate financial targets.
The role involves providing advanced technical support for trading and post-trade processing platforms while leading critical incident management efforts. You will collaborate with cross-functional teams to resolve complex production issues and drive operational excellence.
The Client Services Manager coordinates cross-functional teams to ensure client satisfaction, revenue retention, and successful implementation of payment policy products. They serve as the primary liaison, managing client relationships, operational projects, and performance reporting to drive program success.
The Medical Director serves as a subject matter expert on coding and payment policy, co-captaining the client team and directing the Medical Policy Committee. They are responsible for identifying value-creation opportunities, presenting payment policies to clients, and acting as a clinical liaison.
Oversee complex revenue cycle processes, including payment and adjustment posting, claim research, bank reconciliation, reporting, and audit support, ensuring accuracy, timeliness, and compliance. Serve as a subject matter expert and team mentor, support onboarding and training, resolve client and audit issues, and identify process improvements.
The Manager of Data Engineering AI will lead the data engineering team to develop and implement strategic data architectures leveraging AI innovations. They are responsible for managing staff performance, overseeing IT architecture decisions, and ensuring compliance with regulatory standards like HIPAA.
Lead high-impact digital transformation and process improvement initiatives that leverage AI and automation to drive significant financial value. Manage cross-functional stakeholder engagement, technical documentation, and organizational readiness to ensure successful adoption of strategic solutions.
Lead the administration, governance, and strategic development of the company’s management equity program, including grant planning, vendor oversight, documentation, and compliance coordination. Partner with executives, private equity sponsors, legal counsel, and vendors to model compensation scenarios and prepare clear, board-ready materials.
The Revenue Cycle Specialist is responsible for reconciling payments, managing inventory, and processing invoices to ensure accurate financial records. They also monitor organizational processes for compliance and provide reports to management to improve departmental efficiency.
The Principal Software Engineer will architect and build a unified client performance portal by integrating existing modules and legacy systems. They will lead technical discovery, define integration patterns, and write production-level code while mentoring the engineering team.
The intern will conduct research on Generative AI and AGI for healthcare applications while developing models, architectures, and databases to improve healthcare solutions. They will also collaborate with cross-functional teams to support technology projects and contribute to AI governance programs.
The Senior Revenue Integrity Analyst manages month-end revenue validation controls, investigates revenue leakage, and oversees reconciliation processes. The role also develops actionable reporting, mentors junior analysts, and collaborates across departments to resolve financial discrepancies and improve process efficiency.
The Senior GenAI Scientist II will conduct independent model validation and monitor model performance to ensure responsible AI practices. They will deliver solutions to identify payment integrity issues and improve healthcare outcomes using advanced AI/ML techniques.
The Senior Revenue Integrity Analyst manages month-end revenue validation controls, investigates revenue leakage, and oversees reconciliation processes. The role also develops actionable reporting, mentors junior analysts, and collaborates across departments to resolve financial discrepancies.
The AI Program Manager will lead the development and deployment of AI/ML solutions by collaborating with cross-functional teams to define vision, scope, and roadmaps. They are responsible for driving data-driven decision-making and ensuring the successful execution of AI initiatives from conception to production deployment.
The Senior Support Analyst monitors, analyzes, and resolves technical issues while serving as a liaison between data operations, development, and infrastructure teams. They are responsible for documenting production support processes, managing incident tickets, and providing status reports to business stakeholders.
This role provides senior-level technical support for hybrid environments, focusing on root-cause analysis of complex defects and maintaining CI/CD pipelines. The engineer will manage containerized workloads on AWS EKS and administer legacy Windows and Linux server infrastructure while supporting migration efforts.
The AI Governance Director provides enterprise-wide oversight and coordination for AI governance frameworks, ensuring regulatory readiness and responsible AI use across all business units. The role involves managing AI-related inquiries, chairing governance committees, and maintaining audit-ready inventories of AI use cases.
The Operations Engineer will proactively manage enterprise customer encounters, including installation, configuration, and troubleshooting of complex product issues. They will also collaborate with development and engineering teams to deploy hotfixes, perform performance analysis, and maintain automation scripts.
The Senior Support Analyst monitors, analyzes, and resolves technical issues while serving as a liaison between operations, engineering, and management teams. They are responsible for documenting production processes, coordinating incident resolution, and providing status reports to business stakeholders.
Provide technical and operational support to enterprise customers by resolving product-related issues and managing cloud environments. Collaborate with development and implementation teams to perform testing, validation, and performance analysis for product releases.
The Staff Gen AI Scientist will develop and deploy machine learning solutions to improve healthcare quality and reduce costs. They will collaborate with cross-functional teams to build data pipelines, train models, and monitor performance in production environments.
Lead and manage cross-functional technology delivery teams while championing an AI-native approach to software development. Partner with product, data, and business stakeholders to align engineering plans with corporate strategies and healthcare compliance requirements.
The Senior Technical Product Owner drives solution definitions for pharmacy claim processing and auditing software by translating business needs into testable requirements. They collaborate with cross-functional teams to manage the product backlog, prioritize features, and ensure successful integration across enterprise initiatives.
The intern will design, build, and deploy AI-powered applications and data retrieval systems to improve healthcare operations. They will collaborate with cross-functional teams to develop reliable AI agents, context layers, and governance guardrails.
The Director will lead data governance and analytics architecture initiatives to ensure scalable, standardized, and governed data foundations. They will serve as a consultative technical partner to innovation and analytics teams to drive measurable business outcomes through robust architectural standards.
The Senior Investigator identifies, evaluates, and investigates instances of healthcare fraud, waste, and abuse using data analytics and claims review. They also report findings, conduct training, and support legal proceedings as necessary.
Design and implement a scalable agentic AI framework and centralized platform to support cross-functional AI initiatives. Collaborate with engineering teams to integrate AI agents into applications while ensuring platform reliability, security, and performance.
The Clinical Consultant supports clinical services teams by validating quality and process consistency within the coding validation engine. They act as a liaison between internal teams and clients to provide subject matter expertise, facilitate policy understanding, and assist with appeals management.
The Enterprise Marketing Director is responsible for owning and executing the company's enterprise narrative, category story, and executive-facing positioning across all portfolios. This role also manages analyst relations, competitive intelligence synthesis, and executive support for high-visibility board and investor communications.
The Content Solutions Analyst is responsible for researching and analyzing medical policies to develop logic and algorithms for the payment policy library. They will collaborate with clinical and technical teams to ensure accurate coding and claims processing rules are implemented.
The Client Policy Manager is responsible for maintaining the integrity of client medical payment policies and ensuring they are accurate and up-to-date. They act as a liaison between internal teams and clients, managing policy projects and conducting data analysis to support medical payment decisions.
The Principal AI Engineer will lead the architecture and development of a centralized agentic AI platform for clinical use cases. They will drive technical vision, mentor engineering teams, and ensure compliance with regulatory standards across the software development lifecycle.
The Research Medical Director provides leadership in developing and maintaining medical policies while ensuring accurate interpretation of clinical and payment guidelines. They are responsible for conducting research, performing data analytics, and educating client-facing teams on policy updates.
The Lead Sales Solutions Consultant will lead technical discovery, solution design, and architecture discussions to drive growth across Cotiviti’s healthcare payer solutions. They will support end-to-end pre-sales engagements, including demos, RFP responses, and cross-functional collaboration to ensure scalable and differentiated solution delivery.
The Medical Policy Release Manager oversees the planning, scheduling, and quality assurance of medical policy content and IT system updates. This role acts as a liaison between clinical, IT, and business teams to ensure compliance and minimal disruption during production deployments.
The Platform Systems Analyst acts as a liaison between business stakeholders and technical teams to translate requirements into actionable specifications. They are responsible for optimizing enterprise platforms, managing data flows, and ensuring system alignment with architectural and compliance standards.
The Senior Implementation Consultant will coordinate with clients to install, configure, and deploy Edifecs/Cotiviti solutions based on specific business needs. They are responsible for providing technical support, delivering product training, and mentoring internal teams throughout the implementation lifecycle.
The Senior Operations Engineer manages end-to-end operations for Edifecs application instances, including deployments, configuration, and performance monitoring. They provide L2/L3 technical support to enterprise clients and collaborate with cross-functional teams to resolve complex operational issues.
You will develop and deploy machine learning and generative AI solutions to identify payment integrity issues and improve healthcare outcomes. This role involves collaborating with cross-functional teams to build end-to-end data pipelines and monitor model performance in production.
Drive the planning, strategy, and roadmap for AI solutions and platforms across various lines of business. Manage end-to-end AI programs by coordinating with data science and engineering teams to implement scalable ML and Generative AI techniques.
Design and implement a scalable agentic framework and centralized AI platform to support organization-wide AI initiatives. Collaborate with cross-functional teams to integrate AI agents into internal tools and customer-facing applications while ensuring security and scalability.
Design and implement scalable backend services and RESTful APIs for a centralized AI platform. Lead the development of agent lifecycle management while mentoring mid-level engineers and collaborating on technical architecture.
The manager will identify opportunities to optimize retail audit processes and drive revenue growth through data-driven insights. They are responsible for managing the report development lifecycle and leading a team of professionals to improve internal and external customer satisfaction.
Lead the design and delivery of end-to-end ML/AI systems to optimize payment accuracy and risk adjustment using clinical and claims data. Define technical strategy, build evaluation frameworks, and mentor senior engineers to elevate organization-wide ML standards.
Develop and deploy Generative AI and machine learning solutions to improve healthcare payment integrity and quality of care. Collaborate with stakeholders to assess business problems and build end-to-end data pipelines and models for production.
Perform DRG validation and clinical reviews for inpatient claims to ensure coding accuracy and appropriateness of treatment settings. Document audit results and utilize proprietary systems to generate audit determinations and letters.
Design and evolve intelligent workflow and automation solutions using AI-native development tools and open-source engines. Establish architectural standards and lead a Center of Excellence for AI-enabled workflow development to ensure scalable and secure solutions.
Lead the architectural design and execution for a specific business area, translating product intent into implementable specifications for AI-native solutions. Orchestrate AI agents and engineering workflows to deliver scalable, secure, and maintainable applications within a regulated healthcare environment.
Design and build the backend infrastructure and scalable RESTful APIs for a centralized AI platform. Lead the development of Python/Java SDKs and manage the lifecycle of AI agents within a multi-tenant architecture.
