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Role Description

The Solution Consultant serves as Cotiviti's subject matter expert and "voice of product" for our quality measurement and Star Ratings improvement solutions. This role partners with Sales to pursue strategic opportunities, deliver compelling demonstrations, and provide deep expertise on HEDIS, Star Ratings, and quality improvement programs. The Solution Consultant bridges the gap between customer needs and product capabilities, ensuring Cotiviti's quality solutions address real-world health plan challenges.

Responsibilities

• Pre-Sales Support & Customer Engagement
  • Partner with Sales on strategic opportunities involving quality measurement and Star Ratings solutions.
  • Lead product demonstrations showcasing HEDIS performance analytics, care gap identification, and quality improvement capabilities.
  • Present to health plan quality directors, Star Ratings teams, and executive leadership.
  • Conduct discovery sessions to understand customer quality challenges, current performance, and improvement goals.
  • Support pilot and proof-of-concept initiatives to demonstrate solution value.
• RFP & Proposal Support
  • Develop technical content for quality and HEDIS-focused RFP responses.
  • Articulate how Cotiviti's solutions address NCQA HEDIS certification requirements.
  • Present solutions during finalist presentations with focus on quality improvement outcomes.
  • Support implementation scoping and level-of-effort estimates for complex engagements.
• Market Intelligence & Product Feedback
  • Capture customer feedback on product capabilities, gaps, and enhancement priorities.
  • Monitor competitive landscape in quality measurement and Star Ratings improvement space.
  • Communicate market trends and NCQA specification changes to Product Management.
  • Contribute to sales enablement materials, case studies, and competitive positioning.
• Subject Matter Expertise
  • Maintain deep expertise in NCQA HEDIS measures, specifications, and reporting requirements.
  • Understand CMS Star Ratings methodology, measure weights, and improvement strategies.
  • Stay current on CAHPS survey administration, analysis, and improvement approaches.
  • Develop and deliver training for Sales teams on quality measurement fundamentals.
  • Complete all responsibilities as outlined in the annual performance review and/or goal setting.
  • Complete all special projects and other duties as assigned.

Qualifications

• Bachelor's degree in Healthcare Administration, Public Health, Nursing, or related field.
• 12+ years of experience in healthcare quality measurement, HEDIS operations, or Star Ratings improvement.
• Deep knowledge of NCQA HEDIS measures, specifications, and certification requirements.
• Understanding of CMS Medicare Star Ratings methodology and Part C/D measures.
• Experience in pre-sales, consulting, or customer-facing roles in healthcare technology.
• Strong presentation skills with ability to engage executive and technical audiences.
• Excellent written communication for RFP responses and technical documentation.

Preferred Qualifications

• CPHQ (Certified Professional in Healthcare Quality) or similar certification.
• Experience at a health plan in quality, HEDIS, or Star Ratings role.
• Familiarity with supplemental data strategies and hybrid measure collection.
• Understanding of CAHPS survey administration and member experience improvement.
• Experience with quality analytics platforms and population health tools.

Cognitive/Mental Requirements

• Ability to analyze complex information and communicate it clearly to diverse audiences.
• Strong critical thinking, problem solving, and decision-making skills.
• Capacity to manage multiple priorities and maintain attention to detail.
• Effective memory and recall to stay current on solution knowledge and industry practices.
• Mental flexibility to adapt communication style and approach to different situations.
• Ability to remain composed and think quickly under pressure.
• Strong organizational and planning skills to support client engagements and sales activities.

Physical Requirements and Working Conditions

• Remaining in a stationary position, often standing or sitting for prolonged periods.
• Repeating motions that may include the wrists, hands, and/or fingers.
• Must be able to provide high-speed internet access / connectivity and office setup and maintenance.
• Must be able to provide a dedicated, secure work area.

Benefits

• Base compensation ranges from $140,000 to $175,000 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.
• Cotiviti offers a competitive benefits package including:
  • 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.