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 pre-pay Fraud Waste & Abuse team. 

Strategic Vendor Solutions ("SVS") provides support services to the entire Cotiviti, Inc. ("Cotiviti") organization for the contracting of vendors who provide products and services to Cotiviti as well as any vendors with potential to join Cotiviti's mission through a joint venture, product development or some other form of strategic partnership.   Cotiviti is a leader in analytics driven healthcare payment accuracy and quality-based solutions with locations in the USA, Canada, Australia, Nepal and India and relies heavily on leading edge technology to deliver these products and services to our wide range of customers. SVS is tasked with...

The Senior Project Manager is responsible for leading large-scale, cross-functional, enterprise-wide initiatives with significant executive visibility and business impact. These initiatives may include post-merger integrations, international operational efforts, systems implementations, strategic transformation programs, and other high-priority enterprise projects as assigned.   Given the complexity and variability of each initiative, the Senior Project Manager must apply a diverse range of project management tools, frameworks, methodologies, and leadership approaches to...

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. Your expertise will help clients maximize the value of their Cotiviti investment while expanding our impact across the healthcare payer landscape. The ideal candidate combines strong technical acumen with a deep understanding of healthcare EDI operations, encounter data...

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,...

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.  

We are seeking a passionate, talented, and enthusiastic AI Product Manager 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.

The Policy Design Specialist role is responsible for managing health plan clients and executing monthly project requests. Perform policy configuration maintenance of current medical policies along with implementing new health plan medical policies per client request. Adhere to and remain in alignment with the most up to date healthcare industry medical coding guidelines. Perform data analysis to determine how to accurately apply coding updates and client requested customizations. Execute quality assurance checks to ensure appropriate claim editing recommendations are applied based on client request.

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.

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.

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.   

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.  

We are looking to hire Senior Software Engineer - Full Stack to support CCCR (Cross Claim Clinical Review) as an innovative approach to inpatient clinical reviews, currently available through our Retrospective CCV program. This initiative will extend CCCR to prepay and expand into outpatient and professional claim review as part of PPM to CV. Physician claims are submitted before hospital claims approximately 60% of the time. This enables capturing 60% of retrospective CCCR savings prepayment, accelerating revenue realization and reducing costs. The remaining 40% of savings will continue to be recovered through retrospective CCCR-CCV.

The Clinical Delivery SharePoint Organization Intern will support the Clinical Delivery department by organizing, standardizing, and improving the usability of the department’s SharePoint site. This internship is a short‑term, project‑based role focused on inventorying existing content, improving document structure and naming conventions, and enhancing overall accessibility and usability of departmental resources, including expansion of the chatbot capabilities. The intern will collaborate with department leadership and subject matter experts to ensure content is logically organized, current, and aligned with departmental and information governance standards.

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,...

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 Product Manager leads the strategy, design, and delivery of solutions for Medicare, Medicaid, and ACA Risk Adjustment programs. The role partners with cross‑functional teams to improve documentation accuracy, optimize risk capture, and ensure...

We are seeking a highly skilled and experienced developer to join our dynamic team. The developer will be responsible for designing, developing, and maintaining software applications using various programming languages and technologies. The ideal candidate must have a strong background in Power Apps, Power Automate, AI Builder, and Azure AI Studio, as well as proficiency in languages such as Python, C# sharp, .NET, Blazor, JSON, etc.

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

The Intern Cloud Engineer will focus on developing, optimizing, and supporting cloud-based solutions within Cotiviti’s AWS environment. This internship role reports to the Associate Director AGI Research. This role will focus on leveraging cloud technologies to drive innovation, efficiency, and scalability. 

The Business Operations group works in small project teams to identify and address complex business challenges. The team operates like an internal consulting group to define and drive strategic, operational, and organizational improvements across the business.   Successful candidates will be self-motivated, intellectually curious, fast learners, comfortable with ambiguity and working independently, and able to focus on details while thinking strategically. He or she will have the ability to solve business problems of moderate scope and deliver insights that enable...

The Program Manager, Operations will partner directly with the assigned Client Executive, retrieval, coding, and reporting team leads and will focus on the execution and delivery of the Cotiviti Risk Adjustment Products and Services for enterprise-level accounts. The Program Manager, Operations will directly own assigned accounts and is responsible for overseeing all aspects of our engagement for our Risk Adjustment solution set. The Program Manager, Operations will leverage their deep healthcare and project management knowledge to deliver the highest quality of services to Cotiviti...

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...

We are seeking a highly skilled and experienced Staff Engineer I to join our dynamic team in Payment Integrity. The Staff Software Engineer I (AI-Native Tech Lead) is a senior individual contributor responsible for providing technical leadership, architectural direction, and engineering rigor for a team building software using AI-native development practices.   This role focuses on how AI is used across the software development lifecycle, including design, architecture, 

Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.   The Senior Software Engineer I (AI Orchestrator) is a senior individual contributor responsible for building production 

The Clinical Risk Adjustment Manager serves as Cotiviti's internal subject matter expert on Medicare Advantage risk adjustment methodology, NCQA/HEDIS quality measures, and regulatory compliance. This individual ensures our risk adjustment and quality products remain compliant, effective, and responsive to evolving CMS regulations, industry standards, and market demands. The role combines deep clinical knowledge with strategic market intelligence to inform product development and support commercial success.

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...

The Sr. Technical Program Manager (R&D) is responsible for overseeing the development and execution of complex initiatives that requires coordination of teams using a variety of software delivery practices that will include SAFe. The Sr. Technical Program Managers collaborate 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 the Executive, Finance, Operations, Sales, Marketing, Product Management, R&D, Legal, Compliance, Client Implementations and external vendors. The senior technical program manager needs strong leadership and problem-solving skills to achieve...

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 base in this territory. 

The Sr. Enterprise Process Specialist is tasked with driving large, cross-discipline, company-wide process improvement and operational projects with high executive visibility. These projects include improving operational efficiency and reducing cycle times, international operations and offshoring, deployment of new systems, and other projects as directed. As each improvement project is different, the expectation is to utilize a variety of tools, approaches, and formal methodologies to successfully complete the outlined objectives and may or may not...

Cotiviti focuses on improving the financial and quality performance of our clients. In healthcare, 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.   Our software engineers enable insurance companies to identify risk associated within their membership population, allowing insurance companies to direct resources to members most in need. If you are looking for an opportunity to lead software...

The Client Policy Manager I manages client payment policies by ensuring client’s payment policy is accurate, up-to-date, and complete; executes client-specific requests with guidance from internal team and acts as the internal and external client team liaison.

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 pre-pay Fraud Waste & Abuse team. 

The Vice President, Business Development – Government Healthcare is responsible for devising and executing the strategy for new business opportunities and customers in the Federal Government Healthcare market and in the State Government Healthcare market. This role will drive increased revenue through new contract awards in the Federal Government Healthcare market for the Veterans Administration, Defense Health Agency, and/or the Centers for Medicare and Medicaid Services, and as appropriate other Federal/State Agencies. This position is responsible for activities in the full business development / sales cycle for Government procurements, to include:...

The Sales Enablement Manager plays a critical role in equipping Cotiviti’s client facing teams with the tools, training, insights, and resources they need to sell effectively and consistently. This role partners closely with Sales, Marketing, Product, and GTM Operations to design, build, and deliver scalable enablement programs that enhance sales readiness, support solution knowledge, improve productivity, and drive revenue growth.

The Solution Consultant for Retrospective Risk Adjustment serves as Cotiviti's subject matter expert and "voice of product" in the field for our retrospective risk adjustment solutions. This role partners directly with Sales teams to drive complex deal pursuits, deliver product demonstrations, support RFP responses, and provide deep technical expertise during customer engagements. The Solution Consultant also serves as a critical feedback channel, bringing market intelligence and customer insights back to Product Management to inform roadmap decisions.

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.

The Associate Release Train Engineer will be part of Cotiviti’s Innovation Portfolio Management (IPM) team and will support the management of critical projects within an Agile Release Train (ART) and across matrixed teams. Candidate must have experience in the Scaled Agile Framework (SAFe). Candidate must have understanding of best scrum and agile practices at the Team and Program levels, including being able to guide and coach Agile Teams on Cotiviti and SAFe processes and best practices. Longer term emphasis will be on supporting the RTE in program delivery and risk management (ART coordination) and portfolio management reporting needs for the IPM team.

Cotiviti is a leading solutions and analytics company that leverages unparalleled clinical and financial datasets to deliver deep insight into the performance of the healthcare system. These insights uncover new opportunities for healthcare organizations to collaborate to improve their financial performance, reduce inefficiency, and improve healthcare quality.   The Senior Software Engineer I role is primarily responsible for the support of the existing software applications and enhanced...

This senior sales leadership role is responsible for building, developing, and leading a high-performing team of field sales executives focused on selling Cotiviti’s Retail & Commercial Payment Accuracy solutions—including SaaS-based prevention platforms such as ZHA—to Retail and Commercial organizations across the U.S. The ideal candidate brings extensive experience leading sales teams, deep relationships with senior retail executives, and a track record of selling complex analytics, audit, payment integrity, and SaaS solutions to enterprise-level retailers.   Experience calling on retail C-suite leaders,...

Cotiviti is looking for a Staff Accountant to join our Tax team. Reporting to the Senior Manager Tax, you will provide support for both income and indirect tax areas. The position offers an exciting opportunity for growth within the Company.

The Solution Consultant serves as Cotiviti's subject matter expert and "voice of product" for our quality measurement and Star Ratings improvement solutions. This role partners with Sales to pursue strategic opportunities, deliver compelling demonstrations, and provide deep expertise on HEDIS, Star Ratings, and quality improvement programs.   The Solution Consultant bridges the gap between customer needs and product capabilities, ensuring Cotiviti's quality solutions address real-world health plan challenges.

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.

The Sr. Security Engineer - IAM is responsible for designing, implementing, and maintaining privileged access solutions to secure critical systems and accounts. This role focuses on managing privileged credentials, enforcing least privileged principles, and ensuring compliance with organizational and regulatory standards. The Sr. Security Engineer - IAM works closely with InfoSec, IT operations, and application teams to deploy and optimize the Delinea PAM solution.

As a Data Solution Specialist at Cotiviti, you will play a pivotal role in designing, executing, and optimizing data transformation processes that drive our strategic business objectives. Your focus will be on hands-on development and integration of healthcare data, collaborating with stakeholders to translate business requirements, acceptance criteria, and non-functional requirements—aligned with the SAFe (Scaled Agile Framework)—into actionable data solutions.   You will leverage your technical expertise to ensure the seamless processing and integration of large healthcare datasets. Using advanced tools such as the Hadoop...

The Medical Director (MD) is a key member of the audit, quality assurance and client team. The Medical Director is responsible for representing the team on all audit and appeals decisions. The Medical Director 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 CCV inpatient audit, documentation, and communication of results.

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,...

Technical Architect II provides advanced architectural leadership and guidance in their assigned business area, aligning solution development efforts with the broader architectural vision and roadmap. Technical Architect II’s skills and knowledge must include multiple domains (Application/Solution architecture, Technical/Infrastructure architecture, Information/Data architecture), and extensive experience with relevant implementation technology, platforms, and tools. As a senior leader, a Technical Architect II is expected to influence the assigned organization and work independently with senior business and IT leaders, while acting as a mentor and role model within the development teams. Technical Architect II is...

The Program Manager for Pilots & Proof of Concepts (POCs) is responsible for the end-to-end management and successful execution of all pilot programs and proof-of-concept initiatives within Cotiviti's Product organization. The Program Manager ensures pilots are delivered on time, demonstrate measureable value, and convert successfully into full production engagements.

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.