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Overview
Cotiviti provides healthcare data analytics and payment integrity services for health plans, providers, and retailers. It uses analytics and technology to review medical claims before and after payment to identify improper or duplicate payments, validate coding, and recover overpayments. The company combines capabilities from its predecessors (Connolly and iHealth Technologies) into a single end-to-end platform for pre-payment and post-payment review, enabling more accurate, efficient claims processing. Compared with competitors, Cotiviti leverages its large-scale data assets, extensive experience in healthcare payer analytics, and a broad, end-to-end workflow that covers the full lifecycle of claims payment and audit. Its goal is to reduce waste and abuse in the U.S. healthcare system by improving payment accuracy and recovering improper payments across the claims process.
About Cotiviti
Industries
Data & Analytics
Healthcare
Company Size
1,001-5,000
Company Stage
IPO
Headquarters
South Jordan, Utah
Founded
1979
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Simplify's Take
What believers are saying
- Everest Group named Cotiviti highest-designated Leader for market impact on July 1, 2026.
- Cotiviti certified all NCQA Digital HEDIS measures on June 2, 2026, strengthening renewals.
- Ric Sinclair's March 16, 2026 CEO appointment accelerates platform execution and investor messaging.
What critics are saying
- Edifecs added roughly $2 billion debt in February 2025, tightening refinance pressure before 2028.
- Blue KC litigation and NLRB case expose retaliation, transparency, and claims-review backlash.
- Provider pushback against AI-driven audits can trigger vendor replacement and destroy Cotiviti's core moat.
What makes Cotiviti unique
- Cotiviti combines pre-payment and post-payment integrity with Edifecs interoperability across payer workflows.
- The 2026 platform spans claims editing, risk adjustment, HEDIS, and provider payment operations.
- Cotiviti serves over 300 million U.S. members, giving it scale competitors struggle to match.
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Funding
Total Funding
$4.9B
Above
Industry Average
Funded Over
1 Rounds
Benefits
Health Insurance
Dental Insurance
Vision Insurance
Life Insurance
Disability Insurance
401(k) Retirement Plan
Paid Vacation
Paid Holidays
Remote Work Options
Stock Price
Company News
Cotiviti has launched an enhanced Dental Claim Accuracy solution on its Payment Policy Management platform to help healthcare and dental payers improve claim processing. The URAC-accredited solution unifies dental and medical payment workflows on a single platform, supporting both batch and real-time processing. The new offering features AI-assisted rule authoring, clinical validation by licensed dentists, and enhanced fraud detection capabilities. It integrates with Cotiviti's Payment Clarity platform to provide explanations of claim decisions and executive reporting. Matthew Hawley, Executive Vice President of Payment Integrity for Cotiviti, noted that dental spending has reached an estimated $198 billion per year. The solution aims to address challenges including fraud, waste, abuse, overtreatment, and miscoding that contribute to improper payments and increased administrative burden for payers.
Cotiviti, a healthcare software and data-driven technology company, has appointed John Hallock as Chief Corporate Affairs Officer. Reporting to CEO Ric Sinclair, Hallock will oversee corporate communications, brand development, marketing strategy and investor relations. The appointment comes as Cotiviti expands beyond healthcare enterprise solutions into a system-level platform operating across the healthcare ecosystem. The company aims to establish a structural utility layer governing financial accuracy and decision-making whilst reducing administrative waste and costs. Hallock brings over 20 years of experience building category-defining companies. He previously led communications and investor positioning for Livongo's IPO and athenahealth's IPO. Most recently, he served on the founding leadership team at Smarter Technologies, helping shape the company's creation, platform build and strategic acquisitions.
Cotiviti, a healthcare software and data technology company, is presenting at the ACDIS Conference in Chicago (19–23 April) and NAACOS Spring Conference in Baltimore (22–24 April). The company is showcasing its AI-enabled risk adjustment solutions designed to improve coding workflows and patient outcomes for health systems and accountable care organisations. Cotiviti's expanded provider portfolio combines its clinical expertise with Edifecs' risk adjustment technology, offering capabilities including member suspecting, pre-visit preparation, post-visit review and retrospective coding reviews. The HITRUST-certified solutions aim to improve operational efficiency whilst reducing the need for cost-intensive clinical team reviews. At ACDIS, Cotiviti's Betty Stump will present on navigating risk adjustment challenges and HCC coding standards. Cotiviti's services support over 300 million healthcare consumers across the US.
Cotiviti, a healthcare software and technology solutions provider, has announced a leadership transition. Ric Sinclair will join as chief executive officer and board member on 16 March 2026, whilst Emad Rizk will transition from CEO, president and chairman to senior adviser. Dr Rizk led Cotiviti for a decade, overseeing transformational acquisitions including Edifecs and expanding the company's market presence in partnership with Veritas and KKR. Sinclair joins from Waystar, where he served as chief business officer and helped build a high-growth enterprise technology platform. His focus will be accelerating Cotiviti's transformation, expanding its platform and delivering efficiency improvements across medical and administrative challenges. Cotiviti's technology serves customers providing coverage and care for over 300 million members and patients across the United States.
OPEXUS + Casepoint signs a multi-year contract with Cotiviti to automate the company's internal and external litigation-related processes with a secure and unified legal hold platform.WASHINGTON, May 5, 2025 /PRNewswire/ -- Cotiviti, a leader in data-driven healthcare solutions, has selected the Casepoint legal hold management solution from OPEXUS + Casepoint to support internal investigations and litigation workflows within a single, secure platform. OPEXUS + Casepoint, the trusted leader in regulatory and compliance workflows across corporate and government enterprises, today announced that it has signed a multi-year contract with Cotiviti to provide its powerful, end-to-end legal hold management and eDiscovery platform to the technology and analytics company
Cotiviti is Hiring for 102 Jobs on Simplify!
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About Cotiviti
Industries
Data & Analytics
Healthcare
Company Size
1,001-5,000
Company Stage
IPO
Headquarters
South Jordan, Utah
Founded
1979
Cotiviti is Hiring for 102 Jobs on Simplify!
Find jobs on Simplify and start your career today