Sales VP, Pharmacy Claim Editing Solutions

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

📋 Description

• Take ownership and implement a new sales strategy for Cotiviti’s Pharmacy Claim Editing and Accuracy solutions within a designated territory.

• Identify, qualify, and secure new business opportunities with health plans, payer-owned PBMs, Third-Party Administrators (TPAs), and self-funded plan administrators, including those involved with Medicare Part D, Medicaid, commercial, and ASO lines of business.

• Cultivate and sustain 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, as well as Self-funded plan sponsors and their benefits consultants/advisors (e.g., Mercer, WTW, Aon).

• Lead intricate, multi-stakeholder sales cycles that encompass: Pharmacy claim accuracy and payment integrity use cases, ROI, savings validation, and performance guarantees, as well as Software + services contracting models.

• Develop territory and account plans that are aligned with pharmacy market dynamics, customer priorities, and the competitive landscape.

• Collaborate with internal teams (Product, Clinical Pharmacy SMEs, Legal, Implementation) to: Shape solution positioning and develop executive-level business cases, support RFPs and procurement processes, and deliver compelling value propositions.

• Keep track of competitive activities, pricing trends, and market conditions specifically related to pharmacy claim accuracy and claims auditing.

• Represent Cotiviti at pharmacy-related conferences, industry forums, and executive briefings.

• Maintain precise pipeline management, forecasting, and opportunity tracking within Cotiviti’s CRM.

• Provide regular updates to sales leadership regarding: Pipeline health (sufficiency and velocity), forecast risk, market intelligence, and customer feedback.

• Ensure that all sales activities adhere to Cotiviti policies, compliance standards, and contracting guidelines.

• Complete all responsibilities outlined in the annual Performance Plan and perform other duties as assigned.

⛳️ Requirements

• Bachelor’s Degree 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 preferred).

• Proven success in selling pharmacy claim editing, payment accuracy, utilization management, or related solutions.

• Demonstrated experience in selling to 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 track record in selling pharmacy claim editing, payment accuracy, utilization management, or related Rx industry services.

• Demonstrated experience in closing deals ranging from hundreds of thousands to multi-million-dollar contract values.

• Extensive experience in selling to executive-level stakeholders, including C-suite, SVP, and VP-level leaders 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 (AWP, WAC, MAC, 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 fiduciary/transparency requirements under the Consolidated Appropriations Act (CAA).

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

🏝️ Benefits

• Medical, dental, vision, disability, and life insurance coverage.

• 401(k) savings plans.

• Paid family leave.

• 9 paid holidays per year.

• 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti.