The Coordination of Benefits (COB) & Data Mining (DM) Audit Support is a member of the greater Coordination of Benefits and Data Mining teams. This individual will efficiently and professionally handle daily administrative activities within the COB and DM departments to assist the audit to meet and exceed client expectations. This role requires exceptional verbal communication by audio as well as attentive attention to detail for data entry-related written communication and follow–ups for both internal and external client inquiries to achieve success in the generation of overpayments.

The Clinical Consultant support Clinical Services teams in the validation of quality and processes consistency on the CPE editing engine.     Provides support and subject matter expertise on Coding Validation (CV) to both clients and internal stakeholders during the planning, implementation, go-live, transition to operational team, and through the duration of the contract. Clearly understands and articulates CV concepts and policies. Collaborates with internal teams to provide meaningful input on CV...

A Payment Accuracy, Coordination of Benefits (COB) Specialist, is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans. Our specialists are passionate about what they do and are experts at reviewing, discovering, and validating substantial amounts of data and delivering results and insights for our clients. A Payment Accuracy, COB Specialist, is responsible for reviewing and analyzing claims, member, and group data to identify instances of recoverable claims for the benefit of Cotiviti...

The Manager, Audit Operations (Construction Contract Compliance) provides day-to-day supervision and direction to a construction audit team focused on contract compliance and cost control for large capital projects. This role ensures that all audit activities are executed consistently and accurately, with strong adherence to Cotiviti methodology, client expectations, and construction industry standards.   The ideal candidate is an accomplished,...

The Senior Program Manager, Contract Compliance Operations, is responsible for establishing operational objectives and work plans and delegating assignments to drive the day-to-day operational activities that support the delivery of Contract Compliance audit programs. This role serves as the organizational hub for tracking timelines, establishing and maintaining key performance metrics, and ensuring audit deliverables progress through each stage efficiently. The Program Manager partners closely with Audit Managers, Directors, and cross-functional teams to maintain consistency, transparency, and timely communication across all programs. This position focuses...

The Associate Trainer is a support role responsible for aiding the senior trainer in the development, implementation, and maintenance of training programs for the risk adjustment department. This role has responsibility for the creation of written and visual training materials used in training sessions, tracking and analysis of learning data, and managing training administrative tasks with manager oversite. The associate trainer is expected to co-train classes with leads as needed and develop independent material as assigned.

The HR Business Partner will be a member of a business unit and or functional leadership team and serve as a key business partner to provide strategic and tactical human resources leadership. This role will partner with other HR processes such as talent acquisition, performance management, compensation, organizational effectiveness and benefits.  The HR Business Partner will be involved in employee coaching and development, employee communication; lead innovative HR programs and practices to drive employee satisfaction and retention; partner with management to provide strategic support and leadership, develop successful leaders and build effective teams for the organization; and support broad based...

This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on the following disciplines from a coding and billing perspective: Inpatient DRG/APR-DRG and/or episode of care. This position is responsible for auditing inpatient claims and documenting the results of those audits, with a focus on clinical review, coding accuracy, and the appropriateness of treatment setting and services delivered.  

As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This is not a physical investigator role.

As a Principal Investigator, you will investigate suspected incidents of fraud, waste or abuse.    Information on our Solution: Detect FWA Patterns | Cotiviti

The Team Lead is a member of the Coordination of Benefits team, involving situations in which an individual is covered by two or more health plans. Individuals in the Senior Specialist Team Lead role are passionate about leading a team to accomplish the identified goals for the success of the team, Cotiviti, and client partnerships. This role is responsible for leading a team of individuals to meet established goals and deliver on both internal and external client requirements. This individual will have responsibilities including but not limited to performance management, interviewing, forecast, and...

The Implementation Consultant is a post-sales position focused on individual clients and the implementation of Edifecs solutions they have purchased. This role involves installing, configuring, and overseeing the implementation of Edifecs products for the client. Responsibilities include installing products on Edifecs or client hardware, and configuring and developing programs, tasks, and guidelines to fully implement Edifecs solutions based on the client's specific needs. The Implementation Consultant will serve as the primary technical resource for Client Services, interfacing with the client's technical resources. Duties range from delivering product training to developing and deploying new client-specific requirements. This role...

As a Business Development Representative (“BDR”), you will support the growth of the sales pipeline and expand target account intelligence for Cotiviti. The BDR frequently is the voice of Cotiviti, which sets the tone of the customer experience, particularly in first-contact situations. You will support the management of sales territories by establishing relationships, conducting introductory conversations, and gathering intelligence that enables Cotiviti to favorably compete for the prospects’ business. BDRs support analysis and reporting needs of sales operations by developing business profiles of targeted accounts, also referred to as “New Logos.” BDRs also support marketing program development by...

The Product Manager (within Payment Accuracy Product Suite) will be responsible for product management and development supporting Cotiviti digital / UX. This role is dedicated to creating and optimizing user-centric products that enhance and expand the Cotiviti Payment Clarity service for our clients. This role will serve as a product subject matter expert working closely with stakeholders to drive product requirements, design, and successful delivery. 

Cotiviti is looking for a candidate to join our team as a Regional Vice President, Healthcare Payer Sales. This is a direct sales position with quota responsibility. The ideal candidate will be an articulate, high-energy, self-motivated sales professional with a minimum of 10 years’ experience selling enterprise software solutions to the health insurance industry. If a candidate has experience selling B2B, middleware, data transformation solutions, business intelligence software, or Risk Adjustment that’s a plus. The Regional Vice President, Payer Sales will be responsible for managing all Health Care sales activity for key accounts—growing Cotiviti's revenues and client...

Cotiviti is looking for a candidate to join our team as a Regional Vice President, Healthcare Payer Sales. This is a direct sales position with quota responsibility. The ideal candidate will be an articulate, high-energy, self-motivated sales professional with a minimum of 10 years’ experience selling enterprise software solutions to the health insurance industry. If a candidate has experience selling B2B, middleware, data transformation solutions, business intelligence software, or Risk Adjustment that’s a plus. The Regional Vice President, Payer Sales will be responsible for managing all Health Care sales activity for key accounts—growing Cotiviti's revenues and client...

Cotiviti is a leading provider of payment integrity services to some of the most recognized Canadian retailers. We are seeking innovative thinkers and creative problem solvers who are interested in contributing to improving our retail clients’ profitability and want to be part of a team that provides opportunities for career growth. If you want to make a difference and contribute to the improvement of retail payment integrity, consider an opportunity to join our retail recovery team. What does it mean? Our retail recovery auditors are passionate about what they do. They are experts at reviewing, discovering, validating large amounts of data and delivering results and insights for our clients. Our audit teams...

The Client Medical Director (CMD) is a key member of the Go To Market team. Along with the Client Engagement Leader, the CMD co-captains the team serving the Prospective Payment Management (PPM) client team at the health plan. The CMDs role is to serve as a coding and medical payment policy subject matter expert (SME). The CMD is responsible for directing the Medical Policy Committee (joint committee with health plan MD, coding experts, and payment integrity). The CMD will develop a relationship with the client, review their data, select medical policy to present, serve as SME for clinical and coding expertise, and back end support for the client’s Medical Director. The CMD will evolve as the trusted advisor for the Health Plan...

A Payment Accuracy, Coordination of Benefits (COB) Specialist 1 is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans.   This role is responsible for reviewing and analyzing the multi-client impact, complex member selection, and query or filter construction of data to identify instances of recoverable Coordination of Benefit claims for the benefit of Cotiviti and our clients. This individual works under limited supervision and is responsible for establishing...

A Payment Accuracy, Coordination of Benefits (COB) Specialist 2, is a member of the greater Coordination of Benefits Business Unit (BU). Coordination of Benefits involves situations in which an individual is covered by two or more health plans. The Payment Accuracy, Coordination of Benefits (COB) Specialist 2 position is essentially a subject matter expert (SME), provides innovation to introduce new ideas, research as well as creative thinking. This individual will have the opportunity to demonstrate multi-client...

Cotiviti is looking for VP, Corporate Software Architect who understands large-scale, high-performance product designs and principles, AI innovation to drive Agentic Automation, excellent in SaaS designs, thinks cloud natively, shown expertise in converting application to SaaS services, excellent in communicating with critical customers and hands on in solving problems.   As a VP, Corporate Software Architect, you’ll define how to use the latest technologies and AI innovation to identify and optimize the products to scale and perform better. You will work with cutting edge Cotiviti healthcare applications and SaaS services and help...

The Product Director will drive strategy for Cotiviti’s Payment Integrity Client platform product roadmap. This individual will have responsibility and leadership for understanding and prioritizing market needs, performing competitive analysis, performing product discovery, supporting design, delivering business cases and leading delivery and commercial product launches for new products and capabilities

The Sr. Support Engineer is primarily responsible for the support of the existing software applications and enhance software components deployed in the Cotiviti product suite.  The successful candidate will be required to collaborate effectively with other developers, offshore development team members, business owners, project management, and other internal stakeholders.

The Sr. Technical Product Owner is responsible for driving solution design and definition that support business ideas and product concepts at a team, program, and enterprise level through ideating, gathering, refining and translating product vision and requirements into application software solutions. The Sr. Technical Product Owner has deep domain knowledge, and strong experience in collaborating with a diverse cross-functional team including Product Managers, Solution and Enterprise Architects, User Experience Designers, and teams such as Client Services, Operations, Clinical, Data Science, and Marketing. Sr. Technical Product Owner’s are accountable to facilitate and drive Design Driven...

We are looking for a UX Designer that has a proven track record of leveraging design thinking and user feedback to design experiences that are delightful and motivating. The ideal candidate will be motivated about user-centered design and be able to thrive with minimal process and direction while driving efficiency, consistency and results with cross-functional teams. If you also have a portfolio of professional design projects that includes work with web/mobile applications, we’d like to visit with you.

Join a recently formed team focused on Model Risk and Responsible AI. The Senior GenAI Scientist II – Risk will apply knowledge and experience to real world problems and seek to utilize their skills to reduce the cost of healthcare and improve health quality and outcomes. As a Data Scientist on this team, you will focus on three main project areas: Model Validation, Model Metrics and Monitoring, and Responsible AI. This requires someone with depth in

A Payment Accuracy, Data Mining (DM) Specialist, is a member of the greater Data Mining Business Unit (BU). Cotiviti's Data Mining team configures custom claim reviews to investigate untapped billing compliance issues specific to regulations and contracted policies across product, market, and provider types.   A Payment Accuracy Data Mining (DM) Specialist is responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, identifies and inputs recovery claims, voids, or other over-underpayment types. Documents relevant facts,...

As a Senior Manager of Engineering, you will oversee all operational aspects of software development, ensuring projects are completed on time and within scope. You will provide administrative, technical, and people leadership for multiple, diverse, and geographically distributed teams. Your responsibilities will include providing clear guidance, delivering constructive feedback to team members, and promoting a culture of continuous improvement and innovation.   This is an exciting opportunity to make a significant impact on our organization and contribute to the advancement of healthcare data analytics....

This auditing role will focus on Coding & Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits. with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness...

This auditing role will focus on Coding & Clinical Chart Validation for our Outpatient and Specialty audits. The ideal candidate for this position needs to have both a clinical (nurse) and a coding / auditing background focused on one of the following disciplines from a coding and billing perspective: SNF, IRF, Home Health, APC, ER, Diagnostics and Professional Service. This position is responsible for auditing outpatient/specialty claims and documenting the results of those audits. with a focus on clinical review, coding accuracy, medical necessity, and the appropriateness of treatment setting, and services delivered.

This role is part of the training team for the Clinical Chart Validation team. This position is responsible for improving the technical effectiveness of our teams by planning, developing, and delivering technical training, mentoring, and assessment. The individual will work collaboratively with subject matter experts in the Commercial & Government Audit Teams, Quality Assurance, Concept Development, and others to validate workflows and communication tools to enhance audit productivity, performance, and client satisfaction.

Technical Product Owner (TPO) will serve as a critical bridge between product management, stakeholders, and agile development teams. The TPO will ensure technical implementation aligns with overall business vision and strategy, guiding product development, managing technical aspects, and ensuring product features meet user needs and technical feasibility. This role requires a strong technical background, particularly in Enterprise Data Warehousing and Business Intelligence, and the ability to translate technical requirements into actionable development plans. The ideal candidate will act as a technical resource, address technical debt, and drive technical solutions that support business...

Accountable to internal customers in the pursuit of implementing new and recurring projects. Manages milestone and task execution within implementations projects and internal process improvement efforts. Works directly with implementation managers and internal cross-functional counterparts to ensure timely and quality output of project deliverables including but not limited to data analysis, forecasting, reporting, performance metrics and other operational functions. Maintains project status and issues / risks in the applicable...

The focus of the VP Client Engagement is to develop and execute against growth, renewal and retention strategies on their customers within the top customer tier. The VP Client Engagement is accountable for the coordination and transparency needed to drive a successful, multi-pronged growth and retention strategy as well as a multi-level relationship engagement across the customer leadership team. This individual will develop Strategic account plans for their assigned accounts and work closely with Operations teams to ensure execution against those plans....

The Sales Enablement Manager is a member of the Global Retail Go-to-Market (GTM) team and reports to the VP, Client Engagement. The GTM team is focused on: 1) driving quality growth, 2) accelerating sales productivity, and 3) generating revenue.   The Sales Enablement Manager (SEM) partners with and supports members of the Go-to-Market and Audit Operations teams to support the cultivation and expansion of client relationships, and to enroll new business prospects, to drive top...

A Senior Revenue Cycle Specialist is a member of the Revenue Cycle team within the Yield Management Division. This department may work directly with other members of Yield to ensure department expectations are accomplished. The Sr. Specialist, Revenue Cycle position is responsible for complex levels of recurring and/or daily functions and processes that are necessary for business execution; including but not limited to, ensuring the quality of various functions within the department (check application, offsets, invoicing,...

Join a recently formed team focused on Model Risk and Responsible AI. The Staff GenAI Scientist - Risk will apply knowledge and experience to real world problems and seek to utilize their skills to reduce the cost of healthcare and improve health quality and outcomes. As a Data Scientist on this team, you will focus on three main project areas: Model Validation, Model Metrics and Monitoring, and Responsible AI. This requires someone with depth in

We are seeking an experienced Lead Software Engineer to design and lead the development of a scalable, high-performance FHIR Repository service capable of handling hundreds of terabytes of healthcare data. This system will form the foundation of our next-generation healthcare data platform — powering interoperability, analytics, and compliance across our product ecosystem.   You will be responsible for the architecture, design, and implementation of core services that store, retrieve, and manage FHIR resources at massive scale. The ideal candidate combines deep technical expertise in database scalability, distributed systems, and...

Cotiviti Healthcare is a leading provider of payment accuracy services to the most recognized companies in the healthcare and retail industries. We are seeking innovative thinkers and creative problem solvers who are interested in making a contribution to improving healthcare and want to be part of a team that is expanding rapidly and providing opportunities for career growth. If you want to make a difference and contribute to the improvement of healthcare payment integrity, consider an opportunity to join our team as Platform Product Manager.  

The purpose of the MIPS (Medical Image Processing) Agent is to review and associate medical records to the appropriate requests while maintaining adequate production and quality levels through tracked metrics.   This is a REMOTE Position and TEMPORARY for up to 6 months.  The schedule may require a Tuesday through Saturday commitment. 

As a Senior Investigator, you will investigate suspected incidents of healthcare fraud, waste, or abuse through data analysis (a high level of proficiency with Excel is required). This role will primarily support provider escalations related to Cotiviti's prepayment FWA services.  This is not a physical investigator role.

Provide architecture and design for integrating Edifecs solutions into customer environment to meet customer business needs and technical needs for performance, scalability, maintainability and availability. Mentor implementation consultants and review work products/designs delivered by implementation consultants to ensure that they meet prescribed architecture. Provide software code and other artifacts for complex scenarios. Interface with Edifecs engineering team to understand product reference architecture and convert it into implementation architecture templates. Provide guidance to partners who are implementing Edifecs solution from time to time. Troubleshoot critical and complex issues in production that are escalated by support...

The Lead Implementation Consultant is a post-sales position that focuses on individual clients and implementing Cotiviti solutions purchased by that client. The Implementation Consultant will generally be involved in installing, configuring, and overseeing the implementation of Cotiviti products with the client. This includes installation of products on Cotiviti or client hardware; configuration and development of programs, tasks and guidelines, to fully implement a Cotiviti solution based upon a client’s specific needs. The Implementation Consultant will be the primary Client Services technical resource and will interface with the client’s technical resources. Duties can range from delivery of product training to new...

The Trainer Consultant of Implementations is responsible for providing effective and relevant training to our clients through online, in person and recorded sessions. This is achieved through evaluating the Training Request, communicating with the client and the internal support team, and utilizing tools and techniques to deliver on the objectives. They will apply different forms of technology to measure the success of the training and make updates to the strategy based on the results.

We lead the industry in the breadth and depth of how we support our customers—by becoming an extension of their internal team. Helping our customers deliver world-class care and service is the Professional Services Team. The Professional Services team is seeking Business and Data Analyst – Healthcare Interoperability with strong expertise in healthcare interoperability to support large volume data-driven initiatives that improve healthcare data exchange and integration. This role will focus on understanding complex data sets — including member, claims, provider, clinical, and enrollment data — extracted from multiple source systems and spread across multiple data...

We are seeking a Senior Marketing Operations Manager to drive the execution, optimization, and innovation of our marketing operations and demand generation programs. In this role, you will develop and execute high-impact, integrated B2B demand generation campaigns that support revenue and pipeline goals. Partnering closely across the Marketing and GTM teams, you’ll act at both the strategic and tactical levels to conceptualize, build, track, execute, and optimize campaigns based on performance metrics.  

We are seeking a Principal Interoperability Engineer with deep expertise in FHIR and Clinical Quality Language (CQL), combined with strong software engineering skills in .NET. The ideal candidate will design, implement, and optimize advanced healthcare interoperability solutions, translating complex clinical and quality measure logic into efficient, maintainable, high-performance code. This role requires both strategic technical leadership in interoperability standards and hands-on software engineering excellence. You will work closely with product managers, architects, and engineering teams to ensure compliance with healthcare regulations, data privacy requirements, and...

The DevOps Engineer is the primary owner of the build, test, and release (CI/CD) pipeline process in development and production infrastructures. They are responsible for automating software build plans, deploying software to all application environments, and continuously improving release processes using an array of tools.   

Cotiviti is seeking a Sr Director of Product Marketing to join our Edifecs Product Marketing Team. The Sr Product Marketing Director will play a critical role in several areas of product marketing, including annual and strategic planning, market and competitive research and analysis, product positioning and messaging, sales enablement, including content creation and client presentation support, campaign development and execution, marketing project management, and event support. This associate will be collaborative, strategic, and have the ability to own and

We are seeking a motivated Senior AI Engineer to contribute to the design and development of our agentic framework and centralized AI platform. This role will focus on implementing and integrating AI agents, experimenting with open-source AI tools, and supporting the delivery of customer-facing and internal AI-powered applications. You will work closely with senior AI engineers, backend developers, and product engineers to bring agentic solutions to life, gaining hands-on experience with cutting-edge AI frameworks and infrastructure.