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Cotiviti

Cotiviti

Healthcare payment accuracy analytics provider

AI Governance Director

Full-TimeDeadline 9/4/27
$130k - $180k/yr

+ Discretionary bonus

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

Travel as assigned by leadership, approximately 5%.

About the job

Requirements
  • A bachelor's degree or higher in Computer Science, Engineering, Information Systems, Data Science, Law, Public Policy, Risk Management, or a related discipline is required.
  • An advanced degree, such as a Juris Doctor, master's degree, or equivalent graduate education, is strongly preferred, particularly in law, technology, data, policy, or risk-related fields.
  • At least 10 years of progressive leadership experience in technology governance, risk management, compliance, legal, product oversight, or a related field within a complex, regulated environment is required.
  • At least 5 years of experience in AI, data, or technology governance; regulatory compliance, risk management, or audit readiness; oversight of complex, cross-functional technology or product programs; or responding to client audits, requests for proposals, regulatory requests, or attestations is required.
  • Experience coordinating across business, legal, compliance, and technical teams to establish standards, manage risk, and support enterprise decision-making is required.
  • Experience working in regulated industries such as healthcare, financial services, government contracting, or technology-enabled services is required.
  • Deep experience with AI governance concepts, risk-tiering models, post-deployment monitoring, and audit-ready documentation is required.
  • Experience engaging with external stakeholders, including clients, regulators, or auditors, is required.
  • The role requires strategic thinking, critical analysis, judgment and decision-making, problem solving, systems thinking, learning agility, communication, and conceptual reasoning.
  • The role requires the ability to perform duties with or without reasonable accommodation.
  • The role requires a dedicated, secure work area, high-speed internet access or connectivity, and office setup and maintenance.
Responsibilities
  • Develop and recommend enterprise AI governance standards, reporting expectations, and evidence-collection processes across business units.
  • Maintain and periodically update AI governance policies, standards, procedures, and supporting documentation.
  • Coordinate AI-related client, regulatory, and third-party inquiries, including intake, triage, response coordination, and reporting across business units and corporate functions.
  • Coordinate executive- and Board-level reporting on AI governance, risk management, regulatory developments, and program maturity.
  • Chair or co-chair the AI governance committee and oversee AI intake and risk-tier review processes.
  • Maintain a centralized, audit-ready inventory of AI use cases, including risk assessments, approvals, testing artifacts, limitations, and records retention.
  • Oversee post-deployment monitoring by tracking attestations, mitigation actions, and compliance status while business units remain responsible for execution.
  • Provide governance guidance on external demonstrations or disclosures of AI capabilities to protect intellectual property, security posture, and contractual commitments.
  • Deliver regular leadership reporting on AI governance health, inquiry trends, compliance gaps, risk outcomes, and governance maturity indicators.
  • Coordinate enterprise AI governance training, awareness, and communications programs.
  • Monitor emerging AI laws, regulations, enforcement actions, industry standards, and client expectations and assess their implications.
  • Coordinate preparation for internal audits and external examinations by organizing evidence, managing governance repositories, and tracking findings to closure.
  • Partner with engineering and platform teams to embed governance requirements into development workflows and enable automated evidence capture and controls.
  • Publish governance templates, standards updates, and exemplars to support adoption, consistency, and change management.
  • Work with legal, compliance, privacy, information security, information governance, and business leaders to align AI governance requirements and maintain traceability.
  • Review external AI governance frameworks and standards and recommend practical alignment steps.
  • Help streamline governance workflows and reduce intake-to-decision timelines.
  • Complete responsibilities established through annual performance review or goal setting and complete special projects and other assigned duties.
  • Travel as assigned by leadership, approximately 5%.
Desired Qualifications
  • IAPP Artificial Intelligence Governance Professional certification.
  • IAPP privacy certifications such as CIPP or CIPM.
  • ISO/IEC 42001 Lead Implementer or Lead Auditor certification.
  • ISACA certifications such as CISA or CRISC.
  • Another risk, audit, or compliance certification relevant to technology governance.

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.