Sales VP, Pharmacy Claim Editing Solutions

This is a fully remote position, open to applicants in United States.

📋 Description

• Take charge of implementing a new sales strategy for Cotiviti’s Pharmacy Claim Editing and Accuracy solutions within a designated U.S. territory.

• Identify, qualify, and convert new business opportunities with health plans, payer-owned PBMs, TPAs, and self-funded plan administrators.

• Build and sustain senior-level relationships with stakeholders in health plans, TPAs, pharmacy operations, claims, payment integrity, compliance, finance, procurement, and benefits.

• Navigate complex sales cycles with multiple stakeholders concerning pharmacy claim accuracy, payment integrity, ROI, savings validation, performance guarantees, and software-plus-services contracts.

• Formulate territory and account strategies that align with pharmacy market trends, client needs, and competitive landscapes.

• Partner with Product, Clinical Pharmacy SMEs, Legal, and Implementation teams to enhance solution positioning, executive business cases, RFPs, procurement processes, and value propositions.

• Keep an eye on competitive movements, pricing trends, and market conditions that affect pharmacy claim accuracy and claims auditing.

• Represent Cotiviti at pharmacy conferences, industry events, and executive briefings.

• Ensure accurate pipeline management, forecasting, and opportunity tracking within Cotiviti’s CRM system.

• Provide sales leadership with insights on pipeline health, forecast risks, market intelligence, and customer feedback.

• Ensure all sales activities adhere to Cotiviti’s policies, compliance standards, contracting guidelines, budgets, and performance plans.

• Investigate environmental factors, competitive conditions, customer needs, and market trends; propose strategies to leverage opportunities.

• Suggest enhancements to sales and service delivery programs and processes.

• Complete special projects and additional assigned tasks.

⛳️ Requirements

• A Bachelor’s Degree is required or equivalent relevant experience in Healthcare, Business, Marketing, or a related field.

• 12–15 years of experience in enterprise healthcare hunter sales.

• At least 5+ years of experience selling to health plans, TPAs, or pharmacy benefit organizations; 7+ years is preferred.

• Demonstrated success in selling pharmacy claim editing, payment accuracy, utilization management, or related Rx industry services.

• Experience selling to a minimum of two buyer segments: commercial health plans, Medicare Advantage/Part D plans, Medicaid MCOs, payer-owned PBMs, TPAs, or self-funded employer plans.

• Proven track record of closing deals that range from hundreds of thousands to multi-million-dollar contracts.

• Extensive experience engaging with C-suite, SVP, and VP-level stakeholders across payer and TPA organizations.

• Solid 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.

• Understanding of Medicare Part D payment integrity, CMS compliance requirements, and rebate/DIR dynamics.

• Knowledge of self-funded/ASO pharmacy benefit structures, TPA operating models, and CAA fiduciary/transparency requirements.

• A pre-existing executive-level network within health plan and/or TPA pharmacy organizations is strongly preferred.

• Excellent grasp of enterprise selling disciplines and structured closing processes.

• Strong financial acumen with the ability to convey ROI, savings realization, and value-based pricing.

• Highly organized, self-motivated, and effective in a remote, high-growth environment.

• Exceptional verbal, written, and presentation skills for executive audiences.

• Capability to manage complex pursuits and internal deal teams.

• Experience with Salesforce, MS Dynamics, or similar CRM platforms.

• Willingness and ability to travel 40–60% of the time.

• Strong analytical, research, prospecting, interpersonal, oral, and written communication skills.

• Ability to operate daily functions with minimal direct supervision.

• Capacity to provide a dedicated, secure workspace.

• Must have high-speed internet access/connectivity and an office setup and maintenance.

🏝️ Benefits

• Eligibility for commission.

• Coverage for medical, dental, vision, disability, and life insurance.

• Participation in a 401(k) savings plan.

• Paid family leave.

• Nine paid holidays annually.

• 17–27 days of Paid Time Off (PTO) per year, based on level and tenure.

• Option for remote work.

• Virtual interview process.

• Provision of a dedicated secure workspace and high-speed internet access/office setup by the team member.