Sales VP, Pharmacy Claim Editing Solutions

🕒 Maio 7

🇺🇸 Estados Unidos – Remoto (EUA)

💵 $145.000 - $190.000 / ano

⏰ Tempo Integral

🔴 Especialista

🤑 Vendas

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Cotiviti

SiteLinkedInTodas as Vagas

5001 - 10000 funcionários

⚕️ Seguro de Saúde

💳 Fintech

🤖 Inteligência Artificial

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti é uma empresa de tecnologia e análise em saúde que se especializa em melhorar a precisão e o desempenho dos pagamentos por meio de soluções avançadas de análise de dados. Eles se associam a planos de saúde, agências governamentais e provedores de serviços de saúde para fornecer insights que aprimoram a qualidade e a eficiência na prestação de cuidados. Com soluções como ajuste de risco, gerenciamento de políticas de pagamento e engajamento de membros, a Cotiviti busca otimizar os resultados financeiros e clínicos para o ecossistema de saúde.

Descrição

• Own and execute a new sales strategy for Cotiviti’s Pharmacy Claim Editing and Accuracy solutions within an assigned territory • Prospect, qualify, and close new opportunities with health plans, payer-owned PBMs, Third-Party Administrators (TPAs), and self-funded plan administrators, including organizations supporting Medicare Part D, Medicaid, commercial, and ASO lines of business. • Develop and maintain senior-level relationships with: Health Plan and TPA Executives (President, GM, EVP) Pharmacy Operations, Claims, and Payment Integrity Leadership Medicare Part D compliance, STARS, and regulatory affairs leaders Finance, Network Management, and Policy leaders Procurement and Strategic Sourcing teams Self-funded plan sponsors and their benefits consultants/advisors (e.g., Mercer, WTW, Aon) • Lead complex, multi-stakeholder sales cycles involving: Pharmacy claim accuracy and payment integrity use cases ROI, savings validation, and performance guarantees Software + services contracting models • Develop territory and account plans aligned to pharmacy market dynamics, customer priorities, and competitive landscape. • Collaborate with internal teams (Product, Clinical Pharmacy SMEs, Legal, Implementation) to: Shape solution positioning and executive-level business case development Support RFPs and procurement processes Deliver compelling value propositions • Monitor competitive activity, pricing trends, and market conditions specific to pharmacy claim accuracy and claims auditing. • Represent Cotiviti at pharmacy related conferences, industry forums, and executive briefings. • Maintain accurate pipeline management, forecasting, and opportunity tracking within Cotiviti’s CRM. • Provide regular updates to sales leadership on: Pipeline health (sufficiency and velocity) Forecast risk Market intelligence and customer feedback • Ensure all sales activities align with Cotiviti policies, compliance standards, and contracting guidelines. • Complete all responsibilities outlined in the annual Performance Plan and other duties as assigned.

🎯 Requisitos

• Bachelor’s Degree required or equivalent relevant experience in Healthcare, Business, Marketing, or related field. • 12–15 years of experience in enterprise healthcare hunter sales. • Minimum 5+ years selling into health plans, TPAs, or pharmacy benefit organizations (7+ years preferred). • Proven success selling pharmacy claim editing, payment accuracy, utilization management, or related solutions • Demonstrated experience selling into at least two of the following buyer segments: commercial health plans, Medicare Advantage/Part D plans, Medicaid MCOs, payer-owned PBMs, TPAs, or self-funded employer plans. • Proven success selling pharmacy claim editing, payment accuracy, utilization management, or related Rx industry services. • Demonstrated experience closing deals ranging from hundreds of thousands to multi-million-dollar contract values. • Extensive experience selling to executive-level stakeholders including C-suite, SVP, and VP-level leaders across payer and TPA organizations. • Strong understanding of pharmacy claims processing and adjudication workflows across retail, mail, and specialty channels. • Knowledge of NCPDP standards, benefit design, clinical edits, formulary management, and pricing methodologies (AWP, WAC, MAC, NADAC). • Familiarity with Medicaid pharmacy programs and commercial pharmacy benefits. • Familiarity with Medicare Part D payment integrity, CMS compliance requirements, and rebate/DIR dynamics. • Understanding of self-funded/ASO pharmacy benefit structures, TPA operating models, and fiduciary/transparency requirements under the Consolidated Appropriations Act (CAA). • Existing executive-level network within health plan and/or TPA pharmacy organizations strongly preferred.

🏖️ Benefícios

• medical, dental, vision, disability, and life insurance coverage • 401(k) savings plans • paid family leave • 9 paid holidays per year • 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti