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Cotiviti

Cotiviti

Healthcare payment accuracy analytics provider

AVP Account Management - Government

Full-TimeUpdated on 9/18/2026Deadline 7/15/27
$180k - $210k/yr

+ Discretionary bonus

Expert
Bachelor's, Master's, MBA
Remote in USA
Remote

Travel to clients and prospective clients may be required, up to 15%.

About the job

Requirements
  • A Bachelor of Science or Master of Business Administration in Business Administration or a related degree is required.
  • Strong working knowledge of health insurance industry business operations is required.
  • Fifteen years of experience in the health care industry is required.
  • Experience with strategic planning, operations, marketing, product management, and business planning.
  • Strong presentation skills and customer problem diagnostics and solution design.
  • Strong contract knowledge and knowledge of HIPAA compliance related to the company's Business Associate classification.
  • Ability to maintain high ethical standards.
  • Ability to synthesize and utilize data, mentor staff, and build successful teams.
  • Knowledge of healthcare claims payment policy and processing, claims editing, and fraud detection.
  • Ability to establish and maintain multi-level customer relationships and understand client goals.
  • Willingness and availability to travel up to 15% as required.
  • Strong interpersonal, written, and oral communication skills.
  • Ability to anticipate, identify, and resolve simple to complex problems, with strong troubleshooting skills.
  • Ability to multitask in a fast-paced environment.
  • Excellent computer skills in Microsoft Word, Excel, PowerPoint, and Outlook.
  • Ability to provide a dedicated, secure work area and high-speed internet connectivity with office setup and maintenance.
  • Ability to perform duties with or without reasonable accommodation.
Responsibilities
  • Develop, foster, and maintain relationships with customer accounts as the liaison and client advocate between the company and clients or prospects.
  • Monitor and support client activity, manage problem resolution, escalate customer issues when necessary, and track and close client issues.
  • Manage overall client relationships and internal coordination to achieve customer satisfaction for existing client contracts.
  • Develop and maintain account management plans.
  • Meet regularly with clients to assess account status and progress, client needs and feedback, issue resolution, and account growth opportunities.
  • Communicate with clients regarding new audits, edits, system issues, and upgrades, and communicate client needs and ideas for future development.
  • Review client reporting to manage, monitor, and identify potential problems.
  • Develop and oversee routine client reporting, including Quarterly Business Reviews, weekly status reports, and steering committee updates for the government customer base.
  • Travel to clients and prospective clients to strategically manage client relationships and optimize use of core service offerings.
  • Monitor client needs, solicit requests for additional services and improvements, and ensure customer satisfaction by resolving issues quickly and creatively.
  • Interact with operations and marketing/sales to communicate notable client trends and align company communications with changing client issues, requirements, and attitudes.
  • Synthesize and articulate key findings for operations, sales, finance, product development, and executive audiences using financial and market analysis.
  • Present strategic recommendations proactively.
  • Work with sales, operations, and management to ensure ongoing customer satisfaction.
  • Partner with sales executives to identify sales opportunities and provide support.
  • Report weekly to senior leadership on client satisfaction levels, new client issues, unresolved client matters, and customer-requested needs.
  • Assist with marketing efforts, including attending trade shows and conferences, participating in webinars, and responding to requests for proposals.
  • Hire, develop, coach, lead, and retain top-tier talent while building and improving a team and culture that supports high internal and external customer satisfaction.
  • Complete responsibilities outlined in the annual performance plan and performance review or goal-setting process.
  • Complete special projects and other assigned duties.

About the company

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.

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

  • Ric Sinclair arrived March 16, 2026, signaling a platform-growth reset after Emad Rizk.
  • August 2026 Proactive COB and Dental Claim Accuracy broaden cross-sell beyond medical claims.
  • September 2026 AI governance research and SmartP2P Alerts extend Cotiviti into adjacent workflows.

What critics are saying

  • Cotiviti depends on CMS RAC renewals; rebids after 2028 threaten government revenue.
  • KKR and Veritas recapitalized Cotiviti in 2024, adding leverage pressure and exit discipline.
  • Payers can internalize claims editing with Waystar, Optum, and AI-native stacks, commoditizing Cotiviti.

What makes Cotiviti unique

  • Cotiviti spans prepay, postpay, risk adjustment, COB, and retail recovery across payers.
  • 2026 launches use AI to move payment integrity upstream at enrollment, not recovery.
  • CMS RAC roles in Regions 3, 4, and 5 give unmatched government claims access.

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Benefits

Health Insurance

Dental Insurance

Vision Insurance

Life Insurance

Disability Insurance

401(k) Retirement Plan

Paid Vacation

Paid Holidays

Remote Work Options

Company News

Associated Press
Aug 13th, 2026
Cotiviti launches AI-enabled Proactive COB to resolve health insurance coordination at enrollment

Cotiviti has launched Proactive COB, a coordination of benefits capability that uses AI to identify health insurance coverage issues at member enrolment, before claims are submitted. The solution analyses enrollment and maintenance transactions to detect coverage discrepancies early, allowing health plans to prevent payment errors rather than recover overpayments after the fact. Traditional COB approaches rely on retrospective discovery methods, often missing errors until after claims are paid. Proactive COB combines AI-driven prioritisation with validated member databases and over 25 years of COB experience to maintain accurate coverage records throughout the benefit lifecycle. The capability operates on enrollment data and supports automated updates to eligibility platforms, reducing manual intervention whilst maintaining audit trails. Cotiviti's platform serves customers covering over 300 million members and patients in the US.

Yahoo Finance
Aug 4th, 2026
Cotiviti launches AI-powered dental claim accuracy solution amid $198B annual dental spending

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.

Yahoo Finance
Apr 24th, 2026
Cotiviti appoints John Hallock as chief corporate affairs officer to lead next growth phase

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.

Yahoo Finance
Apr 16th, 2026
Cotiviti showcases AI-enabled provider risk adjustment solutions at US healthcare conferences

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.

Business Wire
Mar 9th, 2026
Cotiviti appoints Ric Sinclair as CEO to drive healthcare platform innovation

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.