C

Cotiviti

Catches billing errors for health insurers

VP Product Interoperability

Full-TimeDeadline 9/30/27
$225k - $265k/yr+ Discretionary bonus
Expert
Bachelor's, MBA
Remote in USA
Remote
ProductTechnical Product Management

About the job

Requirements
  • A bachelor's degree in business, computer science, or information technology, or equivalent professional experience, is required.
  • 10 to 15+ years of progressive insurance and product experience, including at least eight years in senior leadership roles overseeing matrixed teams.
  • 10+ years of experience with increasing responsibility and oversight managing Product, Operations, or Professional Services.
  • 10+ years of healthcare industry experience is preferred, along with previous leadership experience in the appropriate domain, personnel management and presentation skills, and customer problem diagnostics and solution design capabilities.
  • Deep subject matter expertise in payer/provider interoperability and claims processing operations; direct experience managing claims operations or payer/provider interoperability for a health plan is strongly preferred.
  • Deep knowledge of interoperability standards, the regulatory environment, and compliance considerations is required. Ability to measure and articulate the business value of compliance is preferred.
  • Advanced knowledge of claims management ecosystems and the ability to align R&D processes, such as SAFe Agile, with core operational needs.
  • Proven strategic and tactical leadership experience and the ability to pursue and understand cutting-edge technologies.
  • Proven experience in growth-oriented businesses in the healthcare information and analytics space, with strong competencies in developing and leading product development and strategy.
  • Ability to build and motivate high-performance teams.
  • Ability to solve problems, think critically, complete tasks independently, make timely workflow decisions, maintain focus, and assess the accuracy, neatness, and thoroughness of assigned work.
  • Ability to provide a dedicated, secure work area, high-speed internet access/connectivity, and office setup and maintenance.
Responsibilities
  • Own and execute Cotiviti’s market strategy, product roadmap, and commercial growth for health plan interoperability, expanding payer/provider collaboration.
  • Prioritize market needs, conduct competitive analysis, engage internal and external experts, and lead product launches that expand client value and advance Cotiviti’s market position.
  • Own product vision, definition, packaging, and market success across the interoperability platform and commercial solutions.
  • Lead a matrixed, multi-level team to enhance existing solutions and deliver next-generation payer/provider collaboration solutions.
  • Advocate for and ensure that product offerings are FHIR-native and leverage the Interoperability Platform.
  • Leverage subject matter expertise to inform Cotiviti’s strategic plan across business units.
  • Collaborate with executive leadership to develop targets for annual bookings, revenue, expenses, and client satisfaction.
  • Represent the voice of the customer in new product management and development.
  • Develop multi-year roadmaps for payer/provider collaboration, spanning provider workflows through post-adjudication.
  • Provide executive leadership for the interoperability business, including product, market, and operational strategy, revenue growth, client outcomes, and long-term business expansion.
  • Develop and influence corporate strategy related to interoperability, provider connectivity, healthcare data exchange, and payer-provider collaboration.
  • Represent Cotiviti with key clients, strategic partners, regulators, industry consortiums, and market influencers.
  • Provide insight into payer platforms, processes, administrative inefficiency, and payer/provider interoperability.
  • Drive process re-engineering using AI and emerging technologies.
  • Apply knowledge of how payers identify and eliminate administrative waste in claims processing, prior authorization, and other core operational processes through advanced data analytics tools, including strengths and gaps.
  • Apply expertise in how payers perceive and manage costs using siloed or competitive approaches.
  • Own business performance, revenue growth, operating margin achievement, investment prioritization, and long-range financial planning for the interoperability business.
  • Ensure products and operational workflows adhere to state and federal regulations.
  • Lead a multidisciplinary organization through Directors, Senior Directors, and other senior leaders responsible for Product Management, Product Operations, Market Strategy, and Product Commercialization.
  • Lead cross-functional teams across Product, Marketing, Sales, Business Unit Operations, and R&D to develop and launch solution portfolio enhancements.
  • Align with Business Unit and R&D processes, including SAFe Agile, and Product Management teams to deliver capabilities.
  • Define success criteria, review product performance against expectations, and facilitate or influence portfolio changes to improve competitive position and product performance.
  • Own the end-to-end customer experience definition for solutions.
  • Lead completion and maintenance of Ready to Market and Ready to Sell tools, content, and training.
  • Collaborate with the Product leadership team to establish and continuously improve Product Management processes.
  • Assist Business Unit leaders in defining core processes and staffing needs for new solutions.
  • Champion product development and product management practices, ensuring teams have the tools, processes, and skills to build roadmaps aligned with Cotiviti’s strategic and operational plans.
  • Define and execute three-to-five-year growth strategies, including market expansion, partnership strategies, acquisition integration opportunities, and innovation investments.
  • Develop solutions that support profitability, efficiency, and growth targets.
  • Lead others in designing and developing new products.
  • Understand client needs, engage others to solve challenges, and assist in developing pricing strategies to maximize returns.
  • Work with technology, operations, and senior leadership to ensure high-quality releases and demonstrate progress against quality goals through clear metrics.
  • Hire, develop, coach, lead, and retain talent, building and improving a team and culture that supports high customer satisfaction.
  • Complete responsibilities outlined in the annual performance review and/or goal-setting process.
  • Complete special projects and other assigned duties.
  • Perform duties with or without reasonable accommodation.
Desired Qualifications
  • A Master of Business Administration degree is preferred.
  • Ten or more years of healthcare industry experience and previous leadership experience in the appropriate domain are preferred.
  • Direct experience managing claims operations or payer/provider interoperability for a health plan is strongly preferred.
  • Ability to measure and articulate the business value of compliance is preferred.

About the company

Cotiviti sells software and review services that help US health insurers pay medical claims correctly, catch fraud, and track the quality of care their members receive. Its software for HEDIS, the care-quality scores US health plans report, has passed certification by the nonprofit NCQA every year since 2001. Insurers run claims through its coding and payment-policy checks before paying them, while its auditors review medical records and paid claims to recover overpayments. Clients pay it software fees or a share of the savings it finds. Cotiviti began in 1979 by auditing retailers' payments to suppliers, which it still does, and it is based in South Jordan, Utah, and owned by private equity firms Veritas Capital and KKR.

Company Size

5,001-10,000

Company Stage

IPO

Headquarters

South Jordan, Utah

Founded

1979

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Simplify's Take

What believers are saying

  • Its results are measurable: in July 2026, Cotiviti reported catching over $10 billion in claim payment errors during 2025.
  • Every employee shares in ownership: Prosperiti, a plan backed by owner KKR, has covered all 9,000-plus staff since September 2024.
  • Room to build AI skills: 20 of Cotiviti's 82 US openings in October 2026 were AI jobs, including three internships.

What critics are saying

  • Expect new bosses: Cotiviti replaced its CEO of 10 years in March 2026 and named a new COO in September.
  • Debt is heavy: a $5 billion bank loan helped fund KKR's 2024 deal valuing Cotiviti at about $11 billion.
  • An AI rival is bulking up: Machinify bought Medicare auditor Performant for $670 million in October 2025.

What makes Cotiviti unique

  • Medicare relies on it: Cotiviti holds three of the five regional contracts to audit paid Medicare claims.
  • Every major insurer is a client: Cotiviti works with all 25 of the largest US health plans.
  • Remote work is the norm: 81 of 82 US openings on Cotiviti's careers site in October 2026 were remote.

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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

Yahoo Finance
Sep 14th, 2026
Cotiviti appoints Erin Schmuker as chief operating officer to scale operations

Cotiviti has appointed Erin Schmuker as chief operating officer. Schmuker will report to president and chief executive officer Ric Sinclair and join the executive leadership team. Schmuker brings over 20 years of healthcare leadership experience. She joins from Optum, where she most recently served as president of Integrated Pharmacies at OptumRx. Previously, she was managing director of Optum Ireland and UK. As chief operating officer, Schmuker will lead Cotiviti's enterprise operations, focusing on scaling the company's operating model and strengthening execution. She will work to simplify operations and help translate investments in technology and AI into measurable outcomes for clients. Cotiviti describes itself as "The Healthcare Infrastructure Company" and connects data, intelligence, and workflows in the US healthcare system.

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.