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 rela