Senior Director Payment Integrity Operations

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    "description": "<h2>Overview</h2>\n<p>The Sr. Director of Payment Policy Management (PPM) Operations is responsible for overseeing the business operations within Cotiviti’s Payment business unit. This role plays a critical part in supporting sales, client engagement, business improvement, and operational processes. The Sr. Director will provide both strategic direction and team leadership, ensuring exceptional service for clients while positioning the organization for continued growth in alignment with business unit objectives. The ideal candidate will possess strong operational acumen, business transformation and people management skills. S/he will be required to communicate with the client (externally) and various departments of Cotiviti (internally) to ensure high quality of service. Achieving and exceeding service level benchmarks is a key responsibility. Success in this role will depend on a thorough understanding of operational processes and the ability to manage them efficiently amidst frequent changes to meet established SLAs.</p>\n<h2>Responsibilities</h2>\n<ul>\n <li>Represent the business unit and operations by defining operational requirements that enable scalable, efficient, and high-quality delivery.</li>\n <li>Respond promptly to Payment Requests for Information and Requests for Proposals.</li>\n <li>Support client intake requests for the Pre-Payment business unit by understanding client requirements and providing tailored solutions and cost estimates.</li>\n <li>Hire, develop, coach, lead, and retain top-tier talent, fostering a team and culture dedicated to implementing best-in-class practices that drive superior internal and external customer satisfaction.</li>\n <li>Optimize labor and operating expenses while increasing productivity, service quality, and supporting future client growth.</li>\n <li>Collaborate with key partners to ensure operational excellence.</li>\n <li>Sponsor, lead and support operational improvement initiatives related to people, processes, and technology to deliver incremental value, enhance operational efficiency, and meet or exceed service and quality goals.</li>\n <li>Develop lean business cases, establish key performance indicators, and create requirements and test plans for business improvement initiatives.</li>\n <li>Communicate business unit performance and improvement initiatives to relevant stakeholders.</li>\n <li>Enforce Cotiviti’s intellectual property protection best practices.</li>\n <li>Ensure clinical operations comply with regulatory, accreditation, corporate, and client requirements.</li>\n <li>Diagnose and resolve issues, prepare schedules, and set deadlines to ensure timely completion of work.</li>\n <li>Develop short-term and long-term plans to anticipate client needs and drive operational improvements.</li>\n <li>Foster a positive culture that supports corporate goals, encourages initiative, and promotes open communication across all levels of the organization.</li>\n <li>Work closely with and support business leaders throughout the organization.</li>\n <li>Establish and maintain effective client and team dynamics in a highly collaborative manner.</li>\n <li>Manage and delegate team and individual projects and assignments.</li>\n <li>Review performance against operating plans and standards.</li>\n <li>Provide reports and metrics to drive continuous operational quality.</li>\n <li>Cultivate and maintain personal relationships with executive leadership.</li>\n <li>Complete all responsibilities as outlined in the annual Performance Plan.</li>\n <li>Complete all special projects and other duties as assigned.</li>\n <li>Perform duties with or without reasonable accommodation.</li>\n</ul>\n<p>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. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and the requirements of the job change.</p>\n<h2>Qualifications</h2>\n<ul>\n <li>Bachelor’s degree in business, operations, healthcare or equivalent in a related field required and Master’s preferred.</li>\n <li>Relevant certifications such as Lean Six Sigma, PMP, or Certified Payments Professional (CPP) are highly regarded.</li>\n <li>A minimum of 10 years’ experience managing operations, consulting, or healthcare management, including decision rights for hiring and terminating employees, and management of operational budgets.</li>\n <li>Experience in US healthcare health plan operations (pre-adjudication, post adjudication or adjudication) preferred.</li>\n <li>Implementations/transitions experience preferred.</li>\n <li>Exceptional operational acumen, advanced problem-solving capabilities, and proven leadership skills.</li>\n <li>Demonstrated experience collaborating with key stakeholders and executive decision-makers.</li>\n <li>Robust leadership background in directing operational divisions, establishing policies, and driving achievement of division objectives.</li>\n <li>Highly developed interpersonal, analytical, and communication abilities.</li>\n <li>Proven record of delivering significant business improvements and operational excellence.</li>\n <li>Deep expertise in process optimization, enabling simplification and scalable quality solutions.</li>\n <li>Comprehensive understanding of technology, including experience with software development initiatives.</li>\n <li>Extensive experience presenting to clients and senior leadership teams.</li>\n <li>Skilled in responding to client information requests, audits, and proposal submissions.</li>\n <li>Ability to thrive in a fast-paced, high-accountability, and diverse environment, with relentless focus on client and customer service.</li>\n <li>Distinguished leadership qualities and a successful track record in talent management and development.</li>\n <li>Strong analytical and problem-solving acumen, with the ability to deeply assess and resolve operational inefficiencies.</li>\n <li>Superior written and verbal communication skills, including expertise in public speaking.</li>\n <li>Advanced proficiency in Microsoft Office Suite, including Word, Excel, and PowerPoint.</li>\n <li>Professional demeanor with the ability to maintain confidentiality.</li>\n <li>Capable of working independently and collaboratively within team settings; adept at multitasking, prioritizing, and meeting deadlines.</li>\n <li>Experience operating effectively in a matrixed organizational structure.</li>\n <li>Willingness and ability to travel as required.</li>\n <li>Demonstrates flexibility and willingness to actively participate in the operations of a international organization, including attending conference calls scheduled to accommodate global time zones.</li>\n <li>Experience in collaborating with sales teams and driving initiatives that support business growth.</li>\n <li>Consistent track record of achieving and surpassing service level agreements (SLAs) and performance benchmarks.</li>\n <li>Strategic capability to position the organization for sustained growth in alignment with the Payment business unit’s objectives.</li>\n</ul>\n<p><strong>Mental Requirements:</strong></p>\n<ul>\n <li>Communicating with others to exchange information.</li>\n <li>Assessing the accuracy, neatness, and thoroughness of the work assigned.</li>\n</ul>\n<p><strong>Physical Requirements and Working Conditions:</strong></p>\n<ul>\n <li>Remaining in a stationary position, often standing or sitting for prolonged periods.</li>\n <li>Repeating motions that may include the wrists, hands, and/or fingers.</li>\n <li>Must be able to provide a dedicated, secure work area.</li>\n <li>Must be able to provide high-speed internet access/connectivity and office setup and maintenance.</li>\n <li>No adverse environmental conditions are expected.</li>\n</ul>\n<p>Base compensation ranges from $160,000 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 discretionary bonus consideration.</p>\n<p> </p>\n<p>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.</p>\n<p> </p>\n<p>Date of posting: 5/8/2026</p>\n<p>Applications are assessed on a rolling basis. We anticipate that the application window will close on 7/8/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.</p>\n<p>#LI-JB1</p>\n<p>#LI-Remote</p>\n<p>#director</p>",
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