Sales VP, Pharmacy Claim Editing Solutions

📋 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 entities supporting Medicare Part D, Medicaid, commercial, and ASO lines of business.

• Build and nurture 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 involving: Pharmacy claim accuracy and payment integrity use cases, ROI, savings validation, and performance guarantees, as well as software and services contracting models.

• Create territory and account plans that align with pharmacy market dynamics, customer priorities, and the competitive landscape.

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

• Keep track of 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.

• Ensure 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.

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

• Complete all responsibilities outlined in the annual Performance Plan and any additional duties as assigned.

⛳️ 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.

• A minimum of 5+ years selling to health plans, TPAs, or pharmacy benefit organizations (7+ years preferred).

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

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

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

• Extensive experience 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.

• 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).

• An 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.