Job Description
Overview
A Lead Solution Consultant will play a pivotal role in driving Cotiviti’s growth by combining deep technical expertise with strong pre-sales acumen across the healthcare payer landscape. This is a client-facing role requiring the ability to lead technical discovery, perform detailed assessments, and design solution architectures aligned to payer business and IT environments.
The role will support clients across Cotiviti’s Health Enablement, Interoperability, and Payment Integrity solutions, while developing the ability to position integrated, cross-product solutions. This role requires hands-on experience with payer systems, data flows, and regulatory frameworks, along with the ability to translate complex technical concepts into business value. While expertise will span the full Cotiviti portfolio, role may develop deeper specialization in areas such as Payment Integrity.
Responsibilities
Technical Expertise & Domain Knowledge
- Serve as a technical subject matter expert within assigned solution domains, with deep understanding of healthcare payer operations, core administrative systems (e.g., claims, enrollment, prior auth), and data ecosystems
- Contribute to solution designs and recommend technical approaches, including integrations, data flows, and interoperability patterns
- Stay current on payer industry trends, regulatory mandates (CMS, interoperability rules, prior auth), and competitive landscape
- Good working knowledge of claims, membership, payment integrity, risk adjustment, quality measures and provider mgmt. workflows
Discovery, Solutioning & Architecture
- Lead technical discovery sessions, current-state assessments, and architecture discussions with payer clients to identify gaps and solution opportunities
- Support pre-sales engagements end-to-end, including solutioning, whiteboarding, technical validation, and deal strategy in partnership with sales and senior team members
Pre-Sales Execution & Deal Support
- Develop and deliver high-impact demos, technical presentations, and tailored solution proposals aligned to client-specific use cases
- Support complex RFP/RFI responses with detailed technical, architectural, and functional inputs
- Lead or support proof-of-concepts, pilots, and technical workshops to validate solution fit and accelerate deal closure
Account Alignment and Cross Functional Collaboration
- Build and maintain account-specific institutional knowledge, enabling stronger cross-sell and upsell positioning across business units
- Partner closely with sales, product, and delivery teams to ensure feasible, scalable, and differentiated solutions
- Provide customer feedback and requirements to support roadmap planning
- Complete all responsibilities as outlined in the annual performance review and/or goal setting.
- Complete all special projects and other duties as assigned.
- Must be able to perform duties with or without reasonable accommodation.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.
Qualifications
- Bachelor’s degree in healthcare, business, computer science, or a related field
- 8+ years of experience in healthcare payer technology, solution consulting, or solution engineering in a client-facing pre-sales role
- Strong hands-on experience within the payer ecosystem, including core administrative platforms (e.g., claims, enrollment, prior authorization), data integration, and operational workflows
- Proven ability to lead technical pre-sales engagements, including discovery, solution design, architecture discussions, and technical validation
- Understanding of healthcare interoperability standards and technologies, including APIs, FHIR, HL7, and data exchange frameworks
- Broad knowledge of Health Enablement (risk adjustment, quality improvement, consumer engagement), Interoperability, and Payment Integrity domains
- Ability to translate complex technical concepts into clear business value for both technical and non-technical stakeholders
- Excellent communication, presentation, and whiteboarding skills, with experience engaging senior client stakeholders
- Experience working effectively across cross-functional teams (sales, product, engineering, delivery) and manage multiple concurrent priorities
- Willingness to travel as required for client-facing engagements
Preferred Qualifications
- Experience with Cotiviti solutions or similar healthcare analytics and payer platforms
- Deep domain and technical expertise in one or more areas such as Payment Integrity, Interoperability, or Risk/Quality solutions
- Experience with end-to-end solution architecture, including integration patterns, ETL processes, and cloud-based data platforms
- Familiarity with regulatory requirements (e.g., CMS mandates, interoperability and prior authorization rules)
Cognitive/Mental Requirements:
- Ability to analyze complex information and communicate it clearly to diverse audiences.
- Strong critical thinking, problem solving, and decision-making skills.
- Capacity to manage multiple proprieties and maintain attention to detail.
- Effective memory and recall staying current on solution knowledge and industry practices.
- Mental flexibility to adapt communication style and approach to different situations.
- Ability to remain composed and think quickly under pressure.
- Strong organizational and planning skills to support client engagements and sales activities.
Working Conditions and Physical Requirements:
- Remaining in a stationary position, often standing or sitting for prolonged periods.
- Repeating motions that may include the wrists, hands and/or fingers.
- Must be able to provide a dedicated, secure work area.
- Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
Base compensation ranges from $160,000 to $200,000 per year. Specific offers are determined by various factors, such as experience, education, skills, certifications, and other business needs. This role is eligible for commission.
Cotiviti offers team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.
Since this job will be based remotely, all interviews will be conducted virtually.
Date of posting: xx/xx/2026
Applications are assessed on a rolling basis. We anticipate that the application window will close on xx/xx/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.
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Originally posted on Himalayas
