Cotiviti is seeking a passionate and results-driven Technical Customer Solutions Manager to join our team and play a key role in driving long-term success for our clients through the effective use of Cotiviti products. In this strategic role, you will act as a trusted advisor to our healthcare payer clients, leveraging your deep operational knowledge of data processing systems, regulatory compliance, and enterprise system integration. The ideal candidate will leverage their operational knowledge and subject matter expertise on processing data through various systems, recognizing revenue and audit regulations, and technical expertise in all areas related to Payer Gateway solutions (EDI, FHIR, API) to guide customers towards maximizing their business value and maximizing Edifecs' footprint in the healthcare payer space.

• Develop, implement, and complete tactical project plans related to customer issue resolution, quality improvement plans, and program enhancements.
• Act as the lead relationship manager for assigned accounts, coordinating proactive customer communication and cross-functional collaboration
• Lead customers to success by understanding their business needs and aligning Cotiviti software and services to drive high-impact results
• Partner with Account and Product Management on Customer Health, NPS, Executive Business Reviews (EBRs), Expansion, and Renewals by delivering against assigned KPIs
• Forecast and track operational metrics including member volumes, encounter throughput, revenue recognition, and submission accuracy
• Apply deep operational knowledge of CMS regulations and audit frameworks to ensure accurate, compliant processing
• Leverage your expertise in encounter submissions and EDI transactions (834, 837, 835, 270/271) to support client success and issue remediation
• Analyze client support tickets and product issues to identify systemic trends and advocate for internal resolution
• Serve as a key conduit for customer enhancement requests through structured feedback loops to Product Management
• Ensure all contracted deliverables are provided accurately, on schedule, and in alignment with client expectations
• Complete all responsibilities as outlined in the annual performance review and/or goal setting
• Complete all special projects and other duties as assigned
• Must be able to perform duties with or without reasonable accommodation

This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties, and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.

• Master’s Degree OR a minimum of 6 years of relevant experience
• Experience in healthcare, preferably on the Payer side of business
• Operational knowledge on processing data through various systems (QNEXT, Health Edge, ZeOmega, etc.), recognizing revenue and audit regulations, and technical expertise in all areas related to Payer Gateways (EDI, FHIR, API) - Various levels of experience in the payer or risk-bearing provider space
• 6+ years of technical expertise in claims processing, encounter submissions, and risk adjustment workflows
• Fluent in Software as a Service (SaaS) distribution models
• 6+ years of Proven success in healthcare or related technical field
• Understanding of the Commercial, Medicare Advantage, Medicaid, ACA lines of business in a Payer organization
• Solid organizational skills, including attention to detail and multi-tasking abilities
• Familiarity with customer journey mapping and strategic success planning
• Strong working knowledge of Microsoft Office, Freshdesk, SQL, and Jira
• Excellent organizational, communication, and interpersonal skills with a client-first approach
• Experience (certification is a plus) with project management and knowledge of standard methodologies like Agile, Waterfall

Cognitive / Mental Requirements:

• Communicating with others to exchange information.
• Problem-solving and thinking critically.
• Completing tasks independently.
• Interpreting data.
• Making timely decisions in the context of a workflow.
• Maintaining focus.
  
  

Physical Requirements and Working Conditions:

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide high-speed internet access/connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Base compensation ranges from $119,500 to $161,700 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs.

Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 9/29/2025

Applications are assessed on a rolling basis. We anticipate that the application window will close on 10/29/2025, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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