C

Cotiviti

Catches billing errors for health insurers

Principal Sales Solutions Consultant

Full-TimeDeadline 8/7/27
$165k - $200k/yr+ Discretionary bonus
Expert
Bachelor's, Master's
Remote in USA
RemoteTravel is required for client meetings, workshops, conferences, and other business needs.
Solution EngineeringPre-Sales Solution Engineering

About the job

Requirements
  • A bachelor's degree in healthcare, business, computer science, information technology, engineering, or a related field, or equivalent relevant experience.
  • 12+ years of experience in healthcare technology, solution consulting, pre-sales, sales engineering, enterprise architecture, healthcare consulting, or a comparable client-facing role.
  • Significant experience working within the healthcare payer ecosystem and a strong understanding of payer business models, operational processes, technology environments, and data ecosystems.
  • Experience selling, positioning, or supporting complex enterprise healthcare technology solutions.
  • Demonstrated ability to lead strategic discovery, current-state assessments, solution workshops, architecture discussions, whiteboarding sessions, demonstrations, and technical validation.
  • Experience designing and articulating integrated, end-to-end solution architectures, including data flows, integrations, APIs, workflows, and interoperability patterns.
  • Knowledge of payer domains such as claims, encounters, enrollment, eligibility, prior authorization, payment integrity, provider management, risk adjustment, quality improvement, and member engagement.
  • Understanding of healthcare interoperability standards and technologies.
  • Strong commercial acumen and the ability to connect technology capabilities to financial, operational, clinical, member, regulatory, and strategic value.
  • Demonstrated ability to engage credibly with C-suite executives, business leaders, operational stakeholders, enterprise architects, data teams, and technical professionals.
  • Experience developing and delivering executive presentations, solution demonstrations, technical workshops, business cases, and architecture recommendations.
  • Ability to translate complex technical and operational information into clear, compelling, value-oriented narratives.
  • Knowledge of enterprise sales methodologies and practices associated with complex, multi-stakeholder sales cycles.
  • Strong analytical, problem-solving, facilitation, prioritization, and decision-making skills.
  • Excellent communication, presentation, relationship-management, and stakeholder-engagement capabilities.
  • Ability to influence decisions and build alignment without direct authority.
  • Demonstrated ability to work independently, manage multiple concurrent opportunities, and remain effective in a fast-paced sales environment.
  • Ability to collaborate effectively across Sales, Product, Technology, Engineering, Delivery, and client-facing teams.
  • Willingness and ability to travel for client meetings, workshops, conferences, and other business needs.
  • Ability to analyze complex business, operational, regulatory, and technical information and communicate conclusions clearly to diverse audiences.
  • Ability to evaluate incomplete or evolving information and recommend an appropriate path forward.
  • Ability to manage multiple priorities while maintaining accuracy, responsiveness, and attention to detail.
  • Ability to retain and apply evolving knowledge of Cotiviti solutions, healthcare regulations, industry practices, client environments, and competitive offerings.
  • Ability to adapt communication style, presentation strategy, and technical depth to different audiences and situations.
  • Ability to remain composed, think quickly, and respond professionally during high-pressure client and sales engagements.
  • Strong organizational and planning skills to support multiple concurrent opportunities, accounts, and client activities.
  • Ability to remain in a stationary position, including sitting or standing, for prolonged periods.
  • Ability to perform repetitive motions involving the wrists, hands, and fingers.
  • Ability to provide and maintain reliable high-speed internet connectivity and an appropriate remote-office setup.
  • Ability to maintain a dedicated and secure work area.
  • Complete responsibilities outlined through the annual performance review and goal-setting process, as well as special projects and other duties as assigned. Duties must be performed with or without reasonable accommodation.
Responsibilities
  • Lead strategic discovery sessions with prospective and existing healthcare payer clients to understand their business priorities, operational challenges, technology environments, regulatory obligations, and desired outcomes.
  • Conduct current-state assessments of client workflows, administrative platforms, data ecosystems, integration requirements, technical constraints, and organizational readiness.
  • Identify clients’ underlying business problems and translate them into clear solution requirements and success measures.
  • Facilitate executive workshops, architecture discussions, solution-design sessions, and strategic whiteboarding engagements.
  • Serve as a trusted advisor to executive, business, operational, and technical stakeholders throughout the sales cycle.
  • Develop understanding of assigned clients and accounts to provide relevant, informed, and forward-looking solution guidance.
  • Help clients evaluate future-state opportunities related to operational performance, payment accuracy, interoperability, regulatory readiness, data exchange, member experience, and healthcare outcomes.
  • Develop integrated, end-to-end solution strategies connecting Cotiviti capabilities across interoperability, data, analytics, intelligence, workflow, and healthcare payer domains.
  • Design and articulate solution architectures addressing data ingestion, transformation, integration, APIs, interoperability patterns, security, operational workflows, and scalable deployment approaches.
  • Architect the broader client environment and explain how solution components work together to deliver measurable business value.
  • Translate complex business, operational, regulatory, and technical requirements into feasible and differentiated solution designs.
  • Develop current-state and future-state architecture views, data flows, integration models, and solution roadmaps.
  • Balance client requirements with Cotiviti product capabilities, implementation models, delivery resources, and strategic direction.
  • Identify solution assumptions, dependencies, technical risks, implementation considerations, and potential barriers to client adoption.
  • Lead or support proofs of concept, pilots, architecture reviews, and technical validations to confirm solution fit and reduce implementation risk.
  • Lead the technical and solution-consulting strategy for assigned complex healthcare payer opportunities throughout the sales cycle.
  • Partner with Sales to develop pursuit strategies, clarify client value drivers, position Cotiviti differentiators, and align proposed solutions with client priorities.
  • Coordinate Product, Technology, Engineering, Delivery, Security, Legal, and domain experts during complex pursuits.
  • Anticipate and address technical, operational, functional, regulatory, commercial, and competitive objections.
  • Support opportunity qualification by assessing solution fit, technical feasibility, implementation considerations, competitive positioning, and potential client value.
  • Strengthen the sales pipeline by identifying technical differentiators, cross-sell opportunities, expansion opportunities, and future client needs.
  • Maintain a forward-looking perspective on assigned accounts by anticipating client needs and connecting them to the broader Cotiviti portfolio.
  • Reduce sales-cycle friction by aligning client expectations, proposed solution capabilities, and delivery requirements early.
  • Ensure solution commitments are documented, achievable, and aligned with Cotiviti product capabilities and delivery expectations.
  • Develop executive-level narratives explaining why a proposed solution matters, how it supports the client’s strategy, and what outcomes it can deliver.
  • Connect solution capabilities to measurable financial, operational, clinical, member, regulatory, and strategic value.
  • Develop value propositions and business cases that quantify, where feasible, the potential impact of Cotiviti solutions.
  • Apply value-engineering principles to help clients understand expected benefits, improvement opportunities, implementation considerations, and investment rationale.
  • Communicate with C-suite executives, business leaders, operational stakeholders, enterprise architects, data teams, and other decision-makers, adapting depth, terminology, and presentation style to the audience.
  • Build credibility with executive stakeholders by demonstrating healthcare payer knowledge, business acumen, and technical expertise.
  • Lead executive workshops, solution-strategy sessions, technical workshops, and architecture discussions tailored to client priorities, stakeholder needs, and desired business outcomes.
  • Develop business-led solution narratives connecting client challenges, Cotiviti capabilities, architectural choices, and measurable outcomes.
  • Use presentations, demonstrations, and other visual techniques selectively to support the solution narrative and validate fit, avoiding feature-led or isolated product presentations.
  • Lead whiteboarding sessions communicating current-state challenges, future-state designs, workflows, data exchanges, decision points, and expected business value.
  • Respond to real-time questions, objections, competitive concerns, and evolving client priorities while maintaining a coherent strategic narrative.
  • Present healthcare, operating-model, data, and technology concepts clearly and persuasively to executive, business, operational, and technical audiences.
  • Create reusable executive narratives, workshop frameworks, value stories, architectural patterns, presentation materials, and demonstration assets where appropriate to strengthen the Solutions Consulting practice.
  • Serve as a subject matter expert in healthcare payer operations, technology environments, and data ecosystems.
  • Apply knowledge of payer administrative platforms and workflows, including claims, encounters, enrollment, eligibility, membership, prior authorization, provider management, payment integrity, risk adjustment, quality improvement, Stars, HEDIS, and member engagement.
  • Apply knowledge of healthcare interoperability standards and technologies.
  • Apply knowledge of integration patterns, ETL processes, cloud technologies, enterprise architecture, analytics platforms, workflow automation, and complex healthcare data flows.
  • Understand applications of artificial intelligence, machine learning, advanced analytics, and automation to relevant healthcare payer use cases.
  • Maintain current knowledge of CMS requirements, interoperability and prior authorization mandates, market developments, emerging technologies, payer priorities, and competitive offerings.
  • Develop deep expertise in one or more Cotiviti solution or healthcare domains while maintaining the breadth to position integrated, cross-portfolio solutions.
  • Articulate how technical components work together to address broader payer business challenges and produce measurable outcomes.
  • Develop integrated solution recommendations and business cases connecting client priorities to Cotiviti capabilities, differentiators, implementation considerations, and expected outcomes.
  • Ensure client-facing recommendations communicate a cohesive enterprise solution and value strategy rather than disconnected product capabilities.
  • Partner with Sales, Product, Technology, Finance, Legal, Security, and Delivery stakeholders to validate solution strategy, proposed architectures, value assumptions, commitments, implementation assumptions, and delivery requirements.
  • Identify risks, dependencies, gaps, decision points, and areas requiring further validation before commercial or delivery commitments are made.
  • Lead or support proofs of concept, pilots, technical workshops, and other validation activities when they can reduce decision risk and advance client alignment.
  • Lead the solution strategy and substantive technical and value content for proposals and RFP responses; proposal administration and coordination are not the role’s primary purpose.
  • Build and maintain account-specific knowledge to support stronger client engagement, solution continuity, and enterprise growth.
  • Partner with Sales and Account Management to identify cross-sell, upsell, and multi-solution opportunities within existing accounts.
  • Connect immediate client requirements to broader Cotiviti capabilities and longer-term strategic opportunities.
  • Develop an actionable opportunity funnel by identifying emerging needs, future initiatives, and potential transformation priorities.
  • Recognize patterns across clients and markets that may indicate new solution opportunities or evolving buyer expectations.
  • Support larger and more strategic pursuits by positioning Cotiviti as an enterprise solution partner rather than solely as a product or point-solution provider.
  • Partner with Sales, Product, Technology, Engineering, Delivery, Client Engagement, and other internal teams to develop coordinated solution strategies.
  • Engage appropriate product, healthcare-domain, architecture, and delivery experts based on client needs and proposed solution complexity.
  • Translate external client and market insights into actionable internal feedback across clients, the market, Sales, Product, and Technology.
  • Provide structured client, market, competitive, and technology insights to support product strategy, roadmap planning, investment decisions, and innovation.
  • Identify capability gaps and recurring client requirements that may inform future product development or partnership opportunities.
  • Contribute to the Solutions Consulting community by sharing best practices, competitive insights, value-engineering approaches, reusable assets, and architectural patterns.
  • Mentor and provide guidance to other Solutions Consultants during complex pursuits, demonstrations, workshops, and client engagements.
  • Represent Cotiviti at client forums, executive workshops, industry events, conferences, and other strategic engagements as needed.
Desired Qualifications
  • Experience with Cotiviti solutions or comparable healthcare analytics, interoperability, payment integrity, payer technology, or enterprise healthcare software platforms.
  • Deep expertise in one or more areas such as Payment Integrity, Risk Adjustment, Quality, Stars, HEDIS, Interoperability, Prior Authorization, Provider-Payer Connectivity, or payer data exchange.
  • Experience positioning integrated enterprise solutions spanning multiple products, business units, healthcare domains, or technology platforms.
  • Experience with enterprise architecture, APIs, integration patterns, ETL processes, cloud-based data platforms, analytics, workflow automation, and complex healthcare data ecosystems.
  • Familiarity with CMS requirements, interoperability mandates, prior authorization regulations, and other healthcare payer compliance considerations.
  • Experience developing quantified business cases or applying value-engineering principles during complex sales pursuits.
  • Experience supporting proofs of concept, pilots, enterprise transformation initiatives, and strategic account expansion.
  • Experience applying artificial intelligence, machine learning, automation, or advanced analytics to healthcare payer use cases.
  • Experience with consultative selling, design thinking, customer journey mapping, or outcome-based solution development.
  • A master's degree in healthcare, business, technology, engineering, or a related discipline.
  • Relevant healthcare, enterprise architecture, cloud, interoperability, sales engineering, or technology certifications.

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.