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We are seeking a highly experienced Principal AI Engineer to lead the architecture, design, and development of a cutting-edge agentic framework and centralized AI platform that serves as the foundation for the organization's AI initiatives. As the technical lead for the Risk Adjustment (RA) Coding Agent, you will own the end-to-end technical architecture—from clinical NLP integration and production routing to core AI platform components that enable...
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Cotiviti is a leading healthcare analytics solutions company seeking an experienced BI Developer III to join our analytics and business intelligence team. In this role, you will design, develop, and maintain enterprise data warehouse solutions that leverage deep healthcare datasets to drive insight into healthcare system performance. You will translate complex stakeholder requirements into technical implementations while working with cross-functional teams using Safe Agile methodologies to deliver high-quality business intelligence solutions that reshape the economics of healthcare.
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We are a Healthcare Data Analytics company looking for Senior Director, Software Engineering within our Payment business. In this role you will lead, direct, and manage the cross-functional technology delivery team. You will manage all the operational aspects of the software development to ensure business and project objectives are met. You will provide technical, administrative, and people leadership for multiple, diverse, and geographically distributed teams.
You will champion an AI-native approach to software delivery by integrating AI tools, automation, and intelligent engineering workflows across the software...
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The Sr. Software Database Engineer is primarily responsible for designing, developing, and maintaining database applications and reusable software components deployed in the Cotiviti product suite, with a strong focus on performance tuning for large-volume data sets and leveraging AI-assisted development tools. You are expected to foster high performing technical teams. You will be required to collaborate effectively with senior developers, offshore development team members, business owners, project management, and other internal stakeholders.
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The Senior Manager, Quality Assurance leads a team of quality-focused individuals across multiple review types responsible for developing, executing, and continuously improving CCV’s quality assurance programs, and ultimately, delivering value to our clients. This leader oversees the governance of quality standards, criteria, audit guidelines, and monitoring processes to ensure programs are evaluated, maintained, and refined over time. The Senior Manager is responsible for ensuring the accurate application of audit guidelines applied through AI-supported and human-reviewed processes, to support high audit accuracy,...
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The Sr Gen AI Data Scientist I - Generative AI will apply knowledge and experience to real world problems and seek to utilize their skills reduce the cost of healthcare and improve health quality and outcomes. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some...
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The Sr. Software Database Engineer is primarily responsible for designing, developing, and maintaining database applications and reusable software components deployed in the Cotiviti product suite. You are expected to foster high performing technical teams. You will be required to collaborate effectively with senior developers, offshore development team members, business owners, project management, and other internal stakeholders.
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We are looking to add a Senior Audit Support Assistant to our Provider Services team! This role will efficiently and professionally handle more complex, broad daily administrative activities within the audit engagement. Some responsibilities include responding to claim status inquiries, generating reports, managing claim work queues, claim tagging, and data entry. This role works collaboratively with other internal Cotiviti teams to investigate escalated claim questions and advocate resolutions on behalf of providers.
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This Coding Validation Analyst I position will perform daily audits on client data for completeness and accuracy of coding utilizing both coding and clinical knowledge and background to ensure appropriateness for reimbursement and will also respond to provider appeals. This position requires strong organizational skills and the ability to meet strict key performance indicators in a fast-paced work environment. Daily, substantive contact with internal staff.
This is a closely monitored productivity-driven role and can be done anywhere in the continental US (this is shift work and hours need to be flexible...this team runs 24 x 7)....
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The Medical Policy Release Manager is responsible for managing the medical policies releases, release schedule, and IT system related updates. This role oversees
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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...
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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.
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This auditing role will focus on Coding & Clinical Chart Validation for our Inpatient audits (DRG Validation). 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. 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...
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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.
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The Sr AI Product Manager - We are seeking a passionate, talented, and enthusiastic individual to join the AI R&D 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 Senior Product Manager – Edifecs is the liaison between business stakeholders, product management leadership and engineering managers. This role works with these stakeholders to understand current and future needs related to one or more products and/or modules and iteratively develop product features to evolve products based on product roadmap. Senior Product Manager – Edifecs is well versed with working in agile / scrum framework, software development lifecycle and uses this expertise to bridge gap between customer facing product management and engineering /...
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The focus of the AVP, Account Management - GOV is to develop and execute against growth, renewal and retention strategies on all customers within Cotiviti Government Services (CGS). The VP, Account Management 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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The Information Systems Security Manager (ISSM), FedRAMP is responsible for overseeing and sustaining the security authorization and continuous compliance of cloud-based information systems supporting United States Federal Government customers. This role is accountable for ensuring the confidentiality, integrity, availability, privacy, auditability, and accountability of government information systems and associated data.
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The Technical Specialist will collaborate closely with the RCA - Content & Enablement Department, the Implementations Team, and the Audit Operations and R&D teams. This role involves the initial reception and generation of Business Rules, which are crucial for the functioning of RCA’s new platform applications. The Technical Specialist will be tasked with creating the logic for these business rules, ensuring their deployment for operational use, and maintaining comprehensive documentation and impact analysis for each rule. Additionally, the Specialist will act as a key liaison between the operations team and our BRMS Center of Excellence, facilitating effective communication and...
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We are looking for a Senior Principal Machine Learning Engineer to lead the design and delivery of end-to-end ML/AI systems that turn vast volumes of claims, clinical, and member data into measurable performance and reduced waste. You will define technical strategy, drive cross-functional alignment, and own systems that directly shape payment accuracy, risk adjustment, and quality outcomes for the payers we serve. This role sits at the intersection of applied research and production engineering, translating ambiguous, high-stakes problems into...
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This DRG Validation Auditor role is focused on our Cross Claim Clinical Reviews (CCCR). Auditors in this role will be doing DRG Validation for our prepay and retrospective audits and making determinations without a medical record. The ideal candidate for this position needs to have both a strong inpatient HIM/coding background and an understanding of clinical validation. 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...
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We are seeking an Intern-AI Engineer to help design, build, and deploy AI-powered applications that leverage large language models (LLMs) and enterprise data systems. This role focuses on developing practical AI solutions that improve healthcare treatment, payment, and operations through intelligent systems and natural language interfaces. You will work closely with Data Scientists, Data Engineers, and business stakeholders to build the underlying architecture for AI agents - including context layers, data retrieval systems, and governance guardrails - that operate reliably in regulated, data-intensive healthcare environments. This is an excellent...
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The Sr Data Scientist - Generative AI II will apply knowledge and expertise to real world problems to enable healthcare organizations to deliver better care at lower cost through advanced technology and data analytics, helping to ensure the quality and sustainability of how healthcare is delivered in the United States. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some of the most pressing healthcare issues of our time. A Data Scientist at Cotiviti will be given the opportunity to work directly...
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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.
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The Senior Auditor Contract Compliance (Construction) performs contract compliance and cost control audits on construction and capital projects, with a focus on distribution center, data center, corporate office, and retail construction, remodel, and build-out programs. This role applies working knowledge of construction audit practices, including AIA billing formats, job-cost reconciliation, GMP and CMAR contract structures, subcontract reviews, insurance cost validation, and lease and developer cost audits.
The Senior Auditor executes audit testing independently,...
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We are seeking a seasoned Director of Data Engineering to lead and scale a high-performing, enterprise-grade data engineering organization for a healthcare company with petabytes of data. This role is responsible for architecting and governing the data infrastructure and drive the technical roadmap across foundational infrastructure, streaming pipelines, analytics engineering, and AI enablement, and serve as a strategic partner to product, analytics, clinical informatics, and technology leadership
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Technical Architect II designs and evolves intelligent workflow and automation solutions in an AI-native development environment. This role combines expertise in application architecture, workflow orchestration, and enterprise platforms with AI-assisted engineering tools (e.g., Claude, Copilot) to accelerate solution design, code generation, and SDLC execution.
The architect will support the Payment BU Workflow Intelligence & Orchestration Initiative, collaborating on client inquiry and payment workflows, while contributing to a Center of Excellence (CoE) for...
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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,...
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Staff Engineer I (AI, Java) is a senior hands-on technical leader responsible for designing and building intelligent backend services and workflow-integrated solutions within an AI-native development environment. This role combines deep expertise in Java-based systems and workflow orchestration with AI-assisted engineering (Claude, Copilot) to enable scalable automation, intelligent routing, and decisioning.
The role partners with Technical Architects and leads engineering teams to deliver secure, scalable, and reusable services across enterprise workflow platforms.
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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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We are seeking a highly experienced Principal Software Engineer to design and build the backend infrastructure for our centralized AI platform. This role will focus on developing robust, scalable backend services that power our agentic framework and enable teams across the company to securely deploy, manage, and access AI agents through unified APIs and user interfaces.
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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 Payment Accuracy Specialist.
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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. 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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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. This includes but is not limited to managing data implementations, data production, data quality, and data...
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The Cotiviti Retail Business Process Optimization (BPO) Team is seeking a Manager to work closely with our operations, R&D, and client teams. We are looking for an individual who is a self-starter, interested in developing their own skills and experiences as well as being a trusted go-to resource for other BPO team members. We are looking for an individual who is technically sound but also curious and interested in learning our unique and results oriented business. This individual must possess a complete understanding of retail audit recovery work, best practices for managing audit teams, great interpersonal skills and be comfortable with conducting...
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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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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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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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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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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 Director of Quality is responsible for ensuring quality delivery of the Payment Integrity Solution and driving excellence across multiple payment integrity products. This role will develop and implement a quality measurement framework, align quality processes across products, and establish monitoring mechanisms to communicate performance to senior leadership. The Director is focused on continuous improvement, delivering greater quality in support of Cotiviti’s growth strategy. Success in this role requires strong foundations in testing, technology, process management, operational acumen, and collaboration. The Director will engage with clients and internal teams to ensure the delivery of...
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The Sr Gen AI Data Scientist I - Generative AI will apply knowledge and experience to real world problems and seek to utilize their skills reduce the cost of healthcare and improve health quality and outcomes. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some...
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The AI-Native Product Lead is a team-embedded product role responsible for translating business needs into clear, testable, and technically actionable requirements and owning the product backlog for a single AI-Native team. This role serves as the product owner for the team, working closely with the AI-Native Tech Lead and engineers to ensure the team is focused on building valuable, usable, and high-quality software.
This role focuses on solution definition through requirements gathering, feature and user-story creation, backlog prioritization, and story acceptance, while operating within a small, focused team and...
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The Platform Systems Analyst is responsible for analyzing, optimizing, and supporting enterprise platforms to ensure alignment between business needs and technical delivery. This role serves as a critical liaison between business stakeholders, product teams, and technical leads to translate requirements into actionable specifications that enable efficient execution.
This position focuses on requirements clarity, integration coordination, platform enhancements, and operational excellence within established architectural standards.
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The AI-Native Technical Architect II provides advanced architectural leadership within an assigned business area, aligning solution development with broader architecture direction while remaining closely connected to implementation.
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The Research Medical Director is a key member of the Clinical and Policy research development area at Cotiviti. The Research Medical Director is responsible for providing leadership guidance to the clinical teams and ensuring the Rules and policies are accurately interpreted and developed. This role is also responsible for analyzing, interpreting, and developing additional policies that will allow us to enhance our medical policy library. The Medical Director will guide both internal and external processes as related to Payment Policy Management polices and rules.
This is a...
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The Sr Staff AI Scientist- Generative AI will apply knowledge and experience to real world problems and seek to utilize their skills reduce the cost of healthcare and improve health quality and outcomes. With access to dedicated on premise and cloud based big data solutions, the team can work with a vast amount of structured and unstructured data including claims, membership, physician demographics, medical records and others to begin to solve some of the most pressing healthcare issues of our time. A Data Scientist at Cotiviti will be given the opportunity to work directly with a team of healthcare professionals including analysts, clinicians, coding specialists,...
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Working in an agile software development environment, the DevOps / CI-CD Automation Engineer is responsible for automating build-test-deploy lifecycle for wide variety of applications/services in the cloud. As part of the Advanced Solutions Group team you will focus on enhancing platform services and contributing code to multiple automation projects. You will also utilize engineering and programming skills focused on enabling a DevOps model, participating with Architecture, Operations and Engineering teams within Agile processes. The role will include systems and solution design within the existing architecture, as well as design/implementation of improvements to meet business needs. The Senior DevOps engineer will work...