Sales VP, Pharmacy Claim Editing Solutions

🔥 8 minutes ago

🇺🇸 United States – Remote

💵 $145k - $190k / year

⏰ Full Time

🔴 Lead

🤑 Sales

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Cotiviti

WebsiteLinkedInAll Job Openings

5001 - 10000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

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 U.S. territory • Prospect, qualify, and close new opportunities with health plans, payer-owned PBMs, TPAs, and self-funded plan administrators • Develop and maintain senior-level relationships with health plan, TPA, pharmacy operations, claims, payment integrity, compliance, finance, procurement, and benefits stakeholders • Lead complex, multi-stakeholder sales cycles involving pharmacy claim accuracy, payment integrity, ROI, savings validation, performance guarantees, and software-plus-services contracts • Develop territory and account plans aligned with pharmacy market dynamics, customer priorities, and competitive conditions • Collaborate with Product, Clinical Pharmacy SMEs, Legal, and Implementation teams on solution positioning, executive business cases, RFPs, procurement processes, and value propositions • Monitor competitive activity, pricing trends, and market conditions related to pharmacy claim accuracy and claims auditing • Represent Cotiviti at pharmacy conferences, industry forums, and executive briefings • Maintain accurate pipeline management, forecasting, and opportunity tracking in Cotiviti’s CRM • Provide sales leadership with updates on pipeline health, forecast risk, market intelligence, and customer feedback • Ensure sales activities comply with Cotiviti policies, compliance standards, contracting guidelines, budgets, and performance plans • Research environmental and competitive conditions, customer needs, and market trends; recommend strategies to capitalize on opportunities • Recommend improvements to sales and service delivery programs and procedures • Complete special projects and other assigned duties

🎯 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 Rx industry services • Experience selling into at least two buyer segments: commercial health plans, Medicare Advantage/Part D plans, Medicaid MCOs, payer-owned PBMs, TPAs, or self-funded employer plans • Experience closing deals ranging from hundreds of thousands to multi-million-dollar contract values • Extensive experience selling to C-suite, SVP, and VP-level stakeholders 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 including AWP, WAC, MAC, and 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 CAA fiduciary/transparency requirements • Existing executive-level network within health plan and/or TPA pharmacy organizations strongly preferred • Excellent command of enterprise selling disciplines and structured close processes • Strong financial acumen and ability to articulate ROI, savings realization, and value-based pricing • Highly organized, self-directed, and effective in a remote, high-growth environment • Outstanding verbal, written, and presentation skills for executive audiences • Ability to manage complex pursuits and internal deal teams • Experience using Salesforce, MS Dynamics, or comparable CRM platforms • Ability and willingness to travel 40–60% • Strong analytical, research, prospecting, interpersonal, oral, and written skills • Ability to perform daily functions with little or no direct supervision • Ability to provide a dedicated, secure work area • Ability to provide high-speed internet access/connectivity and office setup and maintenance

🏖️ Benefits

• Commission eligibility • Medical, dental, vision, disability, and life insurance coverage • 401(k) savings plan • Paid family leave • 9 paid holidays per year • 17–27 days of Paid Time Off (PTO) per year, depending on level and length of service • Remote work • Virtual interviews • Dedicated secure work area and high-speed internet access/office setup provided by the team member