Sales VP, Pharmacy Claim Editing Solutions

🕒 May 7

🇺🇸 United States – Remote

💵 $145k - $190k / year

⏰ Full Time

🔴 Lead

🤑 Sales

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

⚕️ Healthcare Insurance

💳 Fintech

🤖 Artificial Intelligence

Healthcare Insurance • Fintech • Artificial Intelligence

Cotiviti is a healthcare technology and analytics company that specializes in improving payment accuracy and performance through advanced data analytics solutions. They partner with health plans, government agencies, and healthcare providers to deliver insights that enhance quality and efficiency in care delivery. With solutions such as risk adjustment, payment policy management, and member engagement, Cotiviti aims to optimize financial and clinical outcomes for the healthcare ecosystem.

📋 Description

• 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.

🎯 Requirements

• 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.

🏖️ Benefits

• 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