Sales VP, Pharmacy Claim Editing Solutions

Overview

This is a senior hunter sales role responsible for selling Cotiviti's Pharmacy Claim Editing and Payment Accuracy solutions to U.S. health plans, third-party administrators, and self-funded plan sponsors. Target customers include national and regional commercial health plans, Blues plans, Medicaid Managed Care Organizations, Medicare Advantage and Medicare Part D plans, payer-owned PBMs, Third-Party Administrators (TPAs), and administrators of self-funded employer health plans.

The role requires deep experience selling complex healthcare software and services into Pharmacy Operations, Payment Integrity, Claims, Finance, and Procurement organizations across the health plan, TPA, and self-funded ecosystem. Candidates must demonstrate success selling pharmacy-focused solutions, with experience in pharmacy claim editing, utilization management, benefit configuration, and post-pay or pre-pay accuracy programs highly desired. Familiarity with Medicare Part D payment integrity requirements and self-funded/ASO pharmacy benefit structures is strongly preferred.

The position is responsible for driving new logo acquisition across assigned territories in the United States.

Responsibilities

• 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.

• Research and analyze environmental and competitive conditions, customer needs, and market trends. Recommend strategies to capitalize on market opportunities and ensure strategic sales plans complement marketplace needs.

• Ensure sales activities are cost effective, efficient, and are performed within established budget constraints.

• Provide recommendations for improvements in sales and service delivery, programs, and procedures.

• Complete all responsibilities as outlined on annual Performance Plan.

• Complete all special projects and other duties as assigned.

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.

Qualifications

Education

• Bachelor's Degree required or equivalent relevant experience in Healthcare, Business, Marketing, or related field.

Experience

• 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

Domain Expertise

• 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.

Skills & Competencies

• Excellent command of enterprise selling disciplines and structured close processes.
• Strong financial acumen with 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 tailored for executive audiences.
• Demonstrated 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%.

MENTAL REQUIREMENTS

• Assessing the accuracy, neatness and thoroughness of the work assigned.
• Demonstrated ability to balance activities across multiple internal customers, campaigns, tasks, and performance pressures.
• Strong analytical skills with the demonstrated ability to research prospective customers and plan sales prospecting activities accordingly.
• Excellent oral and written skills.
• Strong interpersonal skills required. Understands that internal customers' interests are best served through continuous prospecting and intelligence gathering activities and proactive communication with sales partners.
• Must be able to perform daily functions with little or no direct supervision.

PHYSICAL REQUIREMENTS AND WORKING CONDITIONS

• 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.
• No adverse environmental conditions are expected.

Base compensation ranges from $145,000 to $190,000 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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