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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...
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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 healthcare recovery team as a Senior Technical Specialist.
This role...
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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 healthcare recovery team as a Payment Accuracy Specialist 2.
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This role is expected to work Saturday through Wednesday from 9:00 AM Pacific to 6:00 pm Pacific
At Cotiviti, we are custodians of data for our clients. Using their technical experience in ETL processes, Data Engineers ensure operational functions are occurring as expected
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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...
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We are in search of a seasoned Senior AI Developer with a specialization in Azure AI Studio, Azure Open AI, Microsoft Copilots, AI and ML methodologies, and AWS Bedrock. In this role, you will be the guiding force behind our AI initiatives, providing expertise and leadership to all users across the organization who have AI use cases. Your focus will be on architecting, developing, and implementing advanced AI solutions while ensuring alignment with best practices and business objectives.
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The Client Service Analyst (CSA) role ensures adequate support for the client-facing team on coding and policy as well as operational related activities. The CSA must be familiar with the day-to-day activities of the Medical Policy Director (MPD) and client-facing Medical Directors.
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The Client Services Manager (CSM) is responsible for coordinating the cross-functional client team and is focused on achieving plans with clients, revenue retention, and client satisfaction and growth for the Prospective Payment PPM and CV products. The CSM serves as both internal and external client liaison accountable for triaging, managing, monitoring and support of client related activity. The CSM builds and sustains client relationships, achieves the client’s recognition of Cotiviti as a...
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We are seeking a passionate, talented, and enthusiastic individual to join the Payment Integrity AI team and help build industry-leading AI technologies, enabling lines of business with cutting edge and impactful solutions. Not only would you accelerate the adoption of AI but also push the boundaries of advanced ML and Generative AI techniques at scale.
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The Rule Value Analysis Analytics (RVA) Product Manager is a visionary, strategic leader responsible for guiding the evolution of the RVA insights platform, a tool that uncovers new savings opportunities for clients. This individual excels in product management best practices, inspires cross-functional teams, and communicates effectively with all stakeholders. The RVA Product Manager is a strong collaborator and communicator, passionate about delivering measurable client value and driving innovation.
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The Cotiviti Retail division are seeking an experienced Scrum Master to lead and support Agile delivery across Retail development teams and initiatives. This role partners closely with product owners, developers, and senior stakeholders to remove impediments, facilitate effective Scrum practices, and drive consistent, high‑quality delivery at scale.
We are looking for a special individual who is not only technically sound but curious and interested in learning our unique and results-oriented...
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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
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The Senior Counsel, Partnerships will be the main legal resource overseeing strategic partnership contracting. The role will also support the Director, Senior Corporate Counsel in overseeing the full life cycle of Cotiviti’s healthcare and non-healthcare vendor contracts – from initial negotiation through execution, ongoing management, renewal, and termination. This role will be responsible for reviewing, drafting, and negotiating a broad range of commercial agreements, including master services agreements, license agreements, SaaS agreements, business associate agreements, non-disclosure agreements, and other related commercial agreements. The ideal candidate will have...
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The Sr. Technical Project Manager will be responsible for managing and coordinating multiple ENR implementation projects at Cotiviti. This role will serve as the primary liaison between the Customer teams and the Cotiviti teams including implementation/delivery, Product and other relevant teams as necessary, ensuring that products/solutions delivered align with agreed upon Customer requirements and the intended business outcomes. The successful candidate will also be responsible for capturing Customer feedback, understanding the reasons behind any gaps, and managing the process to triage and resolve these gaps. The candidate will also support the internal delivery teams from program...
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The Data Solution Specialist role is aligned to our Implementation team and will partner will various divisions and levels of leadership within the whole organization.
They will be accountable to internal stakeholders for the successful implementation of both new and recurring projects. They will manage milestone tracking and task execution for assigned projects and internal process improvement initiatives. This role involves close collaboration with Product Managers and cross-functional teams to ensure the timely and high-quality delivery of project outputs, such as documentation, data analysis,...
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The Immigration Counsel will serve as in-house immigration legal advisor to Cotiviti. They will be responsible for partnering with leadership on company immigration operations in compliance with federal and state laws and administrative policies. This person will act as the extensive knowledge on all immigration related activities including, but not limited to, visa caseloads, immigration law, immigration document retention, communications with employees, etc. The Immigration Counsel will draft key documents, assist in the completion and filing of all immigration related paperwork, present clear recommendations, and assure legal compliance. They will handle the preparation of immigration...
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The Yield Support team works to facilitate daily administrative activities efficiently and professionally within the department and business unit by assisting our Data Mining (DM) and Coordination of Benefits (COB) Specialists, Recovery Operations, Revenue Cycle, and Inventory Management Specialists teams, to achieve success as an overall organization. This team will also work with the greater leadership team to improve and manage our business optimizations as well as meet and exceed our goals and deliver exceptional customer expectations both internally and externally.
As a Yield Support Specialist this role is under direct supervision...
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We are looking for two highly motivated undergraduate interns to join our team working on next-generation Agentic AI platforms and neural-symbolic systems
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The Coordination of Benefits (COB) Manager works within the COB Business Unit, specializing in managing cases where individuals have multiple health insurance plans. In this role, you'll lead a team dedicated to achieving strategic goals that benefit our team, Cotiviti, and our client relationships.
This role is responsible for leading a team of individuals to meet established goals and deliver financial targets as defined by audit expectations and assists the leadership team with developing the team’s strategic plan for future growth. Additionally, people management, interviewing, forecast and budgeting, and retention efforts as...
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In the role of Concept Development Analyst (CDA) within our CCV business unit, you will support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies. This role is primarily focused on applying deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies.
Leveraging your knowledge of inpatient billing, you will contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. Your understanding of healthcare payment methodologies, coding behavior, and reimbursement rules...
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In the role of Concept Development Analyst (CDA) within our CCV business unit, you will support the enhancement and ongoing optimization of claim selection processes and tools, including AI-enabled methodologies. This role is primarily focused on applying deep clinical, coding, analytical, and reimbursement expertise to strengthen and operationalize existing selection strategies.
Leveraging your knowledge of inpatient billing, you will contribute to improvements in proprietary claim selection tools that drive accurate, compliant, and scalable payment integrity outcomes. Your understanding of healthcare payment methodologies, coding behavior, and reimbursement...
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The Software Engineer is responsible for designing, developing, and maintaining software applications and reusable components for the Cotiviti product suite, following established Software Development Life Cycle (SDLC) methodologies. This role ensures compliance with coding standards, technical design specifications, and quality assurance processes....
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Cotiviti is looking for a manager who will oversee daily operations of data pipelines, ETL processes, and system integrations to ensure data quality, integrity, and timely delivery to stakeholders. This role will help develop and implement data management policies, manage and mentor staff, collaborate with cross-functional teams to translate business needs into technical requirements, and manage budgets, resources, and project risks. The manager will also drive continuous improvement, monitor operational metrics, and report findings to senior leadership.
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This is a senior hunter sales role responsible for selling Cotiviti’s Pharmacy Claim Editing and Payment Accuracy solutions to U.S. health plans, third-party administrators, and self-funded plan sponsors. Target customers include national and regional commercial health plans, Blues plans, Medicaid Managed Care Organizations, Medicare Advantage and Medicare Part D plans, payer-owned PBMs, Third-Party Administrators (TPAs), and administrators of self-funded employer health plans.
The role requires deep experience selling complex healthcare software and...
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This auditing role will be responsible for performing retrospective clinical chart reviews on Readmission and Place of Service Claims by utilizing nationally accepted guidelines, clinical review judgment and review methodologies specific to the contract for which services are being provided. This involves accessing proprietary systems to audit medical records, applying critical thinking and decision-making skills, and accurately documenting a rationale with the findings and supporting references. The ideal candidate for this role would be a Registered Nurse with experience in utilization or case management.
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The Senior Manager Program Management – Payment serves as a people leader responsible for overseeing program delivery while directly leading, coaching, and developing a team of project management professionals. This role balances strategic execution with day-to-day people leadership to ensure successful delivery of payment-related initiatives aligned with business objectives.
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The Senior Implementation Consultant assists in the testing and implementation of Edifecs’ solutions purchased by that client. The Implementation Consultant will generally be involved in installing & configuring under the direction of the Technical Project Manager and/or Implementation/Solution Architect. This includes installation of products on client hardware; configuration and development of programs, tasks and guidelines, and setup to fully implement an Edifecs solution. Duties can range from delivery of product training to new client specific requirements, development and deployment. The role involves client coordination and communication as well as technical understanding...
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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.
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Provides analysis of quantitative and qualitative data from internal and external data sources in support of business decisions. Job Duties: Uses standard or ad hoc queries or reports to extract data from disparate databases or data sources. Analyzes data to produce dashboards, metrics, or insights and identify trends or anomalies. Consults with users or decision makers to identify data sources, required data elements, or data validation standards. Collaborates with development teams to design business intelligence solutions to facilitate data gathering, storage, and retrieval. Experience and Education: Performs work under minimal supervision. Handles complex issues and problems, and refers only the most complex...
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The Director of Solution Innovation Strategy leads early-stage solution strategy and innovation shaping for emerging healthcare opportunities. This role identifies, frames, and advances high-value solution concepts at the intersection of healthcare business needs, operational realities, market direction, and enabling technology. The role is translational in nature: it is not a pure product role, pure research role, or pure technology strategy role. Instead, it bridges what is technically possible to what is strategically useful,...
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At Cotiviti, we are custodians of data for our clients. Using their technical experience in ETL processes, Data Engineers ensure operational functions are occurring as expected. This includes but is not limited to managing data implementations, data integrations, data production, data quality, and data security.
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The Implementation Consultant assists in the testing and implementation of Edifecs’ solutions purchased by that client. The Implementation Consultant will generally be involved in installing & configuring under the direction of the Technical Project Manager and/or Implementation/Solution Architect. This includes installation of products on client hardware; configuration and development of programs, tasks and guidelines, and setup to fully implement an Edifecs solution. Duties can range from delivery of product training to new client specific requirements, development and deployment. The role involves client coordination and communication as well as technical...
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This is a senior hunter sales role focused on selling Cotiviti’s Dental Claim Accuracy solutions to Dental Benefit Administrators (DBAs) and Health Plans that administer dental benefits. Target customers include organizations such as Delta Dental Plans, MetLife Dental, Guardian, Cigna Dental, Aetna Dental, UnitedHealthcare Dental, Blue Cross Blue Shield plans with dental lines of business, and regional dental administrators.
The role requires extensive experience selling complex healthcare software and services into dental payer organizations, with demonstrated success...
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Cotiviti, Inc. drives better healthcare outcomes through data analytics. This means taking in billions of clinical and financial data points, analyzing them, and then helping our clients discover ways they can improve efficiency and quality.
Learn more at www.Cotiviti.com.
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The Sr. Director of Payment Policy Management (PPM) Operations is responsible for overseeing the business operations within Cotiviti’s Payment business unit. This role plays a critical part in supporting sales, client engagement, business improvement, and operational processes. The Sr. Director will provide both strategic direction and team leadership, ensuring exceptional service for clients while positioning the organization for continued growth in alignment with business unit objectives. The ideal candidate will possess strong operational acumen, business transformation and people management skills.
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The Sr. Technical Program Manager is responsible for overseeing the development and execution of complex initiatives that require coordination of teams using a variety of software delivery practices, including SAFe. The Sr. Technical Program Manager collaborates closely with cross-functional teams to ensure projects are delivered on time, within budget, and meet the required quality standards. Programs can involve simultaneous coordination across Business Units and Agile Release Trains as well as working with the following departments: the Executive Office, Finance, Operations, Sales, Marketing, Product Management, R&D, Legal, Compliance, Client Implementations and external vendors....
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The Generative AI Research Engineer Intern 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.
We are currently looking for interns...
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At Cotiviti, we are custodians of data for our clients. Using their technical experience in ETL processes, Data Engineers ensure operational functions are occurring as expected. This includes but is not limited to managing data implementations, data integrations, data production, data quality, and data security.
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The Audit Quality Specialist (AQS) is a member of the greater Data Mining and Coordination of Benefits business unit where Cotiviti employees are responsible for auditing client data and generating high quality recoverable claims for the benefit of Cotiviti and our clients. Under direct supervision, the AQS is responsible for post-audit internally and externally for the quality and compliance of audit engagements, ensuring expectations are met as well as established standards and requirements. This team works closely with internal audit teams to provide guidance, support, and oversight throughout the audit process. This is an entry-level position supporting client requests, overpayment quality review, system reconciliation, and claim audit requests. Documentation...
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The Technical Analyst will serve as a key contributor in delivering technical support and platform optimization for enterprise GTM systems, including SharePoint, CRM, and related applications. This hands-on role combines deep technical expertise with business acumen to translate complex requirements into scalable solutions that enhance functionality, system performance, and user experience. The Technical Analyst also functions as the primary point of coordination for interdepartmental GTM technical needs—intaking requests, clarifying requirements, triaging issues,
and partnering with IT, Product, Security, and other stakeholders to drive timely resolution and...
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This internship centers on researching and developing advanced healthcare informatics solutions with a specialization in Agentic AI—AI systems capable of autonomous reasoning, decision-making, and goal-directed behavior. The intern will explore applications of Agentic and Generative AI in healthcare, supporting improvements in treatment, payment, and operations. You will play a key role in developing, analyzing, and collaborating on
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The Project Manager – Payment owns delivery of defined project(s) from initiation through close. Ensures plans are realistic, stakeholders are aligned, execution stays on track, and risks/issues are actively managed.
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The Content Solutions Analyst I is a key member of the clinical operations and content team responsible for the research, quality assurance, and opportunity analysis associated with new medical policies. In addition, this position will be responsible for review and analysis of current medical policies and assisting in the research necessary to define additional logic and algorithms to expand the Cotiviti payment policy library.
The Content Solutions team works within Payment Policy Management and supports all of our PPM Solutions: outpatient, inpatient,...
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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.
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The Sr. Auditor, Quality Assurance position is responsible for ensuring that the audited claims meet quality standards necessary to generate high quality recoverable claims for the benefit of Cotiviti and our clients. Audited claim types include: Outpatient and Specialty Review Types to include SNF, IRF, HH, DME, Hospice and medical necessity. Quality assurance emphasizes compliance with established procedures, accuracy of claim identification and supportive documentation. Identifies and notifies management of observed quality and communicates opportunities for process improvements based on independent audit claims review. Displays professional...
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Cotiviti is seeking a forward-thinking Technical Architect to join the team. This is a high-impact, hands-on leadership role responsible for defining and governing the end-to-end technical architecture of a mission-critical Commercial & CMS audit platform — while simultaneously driving the platform’s AI-native transformation.
The ideal candidate brings deep enterprise architecture expertise, proven...
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The Senior Program Manager, Operations partners closely with assigned Client Executives and internal delivery teams to lead the execution, coordination, and ongoing delivery of Cotiviti’s Quality, Value‑Based Payment, and related platform solutions. This is a dedicated role serving as the primary day‑to‑day program lead for a strategic client and is accountable for overseeing all aspects of the client engagement across multiple products, teams, and workflows. The Senior Program Manager applies deep healthcare domain knowledge in Value Based...
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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.
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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.
This role aligns with our post-pay Fraud Waste & Abuse team.