Senior Manager Quality Audit Operations

Cotiviti•Remote,

2d•$120,000 - $160,000•Remote

About The Position

The Senior Manager, Quality Assurance, leads a team of quality-focused individuals responsible for monitoring and continuously improving CCV’s systems and tools, ensuring CCV consistently delivers value to our clients. This leader serves as a vital link between technical experts, business stakeholders, and leadership across CCV and the organization. This role is responsible for guiding the delivery of services to clients by planning, supporting and / or managing activities from the time after implementation forward. This individual oversees the governance of quality standards, criteria, and monitoring processes to ensure programs are evaluated, maintained, and refined over time. The Senior Manager is responsible for ensuring end-to-end delivery that reliably protects client value. Grounded in Cotiviti’s values—Deeply Curious, People Obsessed, Make it Count, and Build it Better—the Senior Manager fosters a culture of inquiry, accountability, collaboration, and continuous improvement. This role will also focus on incorporating innovation and AI into the QA program to make it more proactive and effective in identifying, prioritizing, and closing vulnerabilities. The role is expected to move beyond reporting results to proactively identify emerging risks, influence corrective action, and confirm measurable, sustained improvement across CCV’s tools and systems. The Senior Manager serves as a business partner to operational leaders while fostering alignment among key stakeholders across CCV operations, concept development, machine learning and strategic analytics, and client service teams. In this capacity, the Senior Manager acts as a vital link between technical experts, business stakeholders, and leadership across the organization, overseeing the governance and integrity of the data, file layouts, and reporting artifacts that feed audit and quality analytics, and providing guidance, mentorship, and performance oversight to team members as a point of escalation and a key driver in defining and refining quality processes.

Requirements

Bachelor’s degree in related field required; Bachelor’s degree with a quality, healthcare, or analytical focus preferred - quality management or health administration preferred, but may also include statistics, mathematics, industrial engineering, or computer science (focus in data management and analysis).
3+ years of technical leadership experience: people and projects.
AI-native experience using generative AI applications such as Claude, Microsoft Copilot, or similar tools to improve analysis, workflow efficiency, communication, decision support, and quality program execution.
AI accuracy mindset: understanding of validation, exception review, quality drift, and human-in-the-loop controls, with the ability to translate these into measurable accuracy improvement.
Consultative influence: uses data and business context to influence teams and drive corrective action without creating defensiveness.
Proven experience influencing behavior, reinforcing expectations, and driving adoption of process, quality, or performance improvements across audit teams.
Remediation execution: builds practical remediation plans with clear owners, milestones, measurable success criteria, and follow-through.
Executive communication: able to communicate complex quality and risk concerns in a concise, balanced, and leadership-ready manner, with appropriate urgency.
Advanced knowledge of Excel (Pivot Tables, Macro's, V Lookups, queries, advanced written formulas).
Strong analytical and problem-solving ability.
Organizational skills.
Attention to detail and accuracy.
Desire and capacity to learn new concepts and software.
Excellent written and verbal communication skills.
Experience in a HIPAA-regulated environment.
Comfortable speaking in front of a group, with clients, and working with physician executives.
Professional with ability to properly handle confidential information.
Ability to work well independently and in a team environment.
Ability to handle multiple tasks, prioritize and meet deadlines.
Ability to mentor staff and enhance performance.
Skilled in root cause analysis, trend monitoring, and risk segmentation to distinguish isolated issues from systemic or client-impacting trends.
Demonstrated technical aptitude, including the ability to write/run SQL queries and interpret data flows, to investigate audit and quality data issues and partner with technology teams on file layouts and data ingestion artifacts underlying the QA program.
Experience managing data governance, data migration, or ETL processes, with an understanding of database design, is a plus for overseeing the data and reporting artifacts that support the QA program.
Communicating with others to exchange information.
Problem-solving and thinking critically.
Completing tasks independently.
Interpreting data.
Making timely decisions in the context of a workflow.
Maintaining focus.
Assessing the accuracy, neatness and thoroughness of the work assigned.
Learning new tasks and completing tasks in situations that have a speed or productivity quota.
Remembering and adhering to processes and protocols.
Applying established protocols in a timely manner.
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.
Remaining in a stationary position, often standing or sitting for prolonged periods.
Repeating motions that may include the wrists, hands, and/or fingers.

Nice To Haves

Experience with quality management methodologies (e.g., Six Sigma, Lean, or CAPA) is a plus.
Experience developing or maintaining quality assurance programs, audit methodologies, or quality monitoring systems is a plus.
Knowledge of medical reimbursement/payment policies, audit review methodologies, and medical terminology is a plus.
Familiarity with data analytics tools and platforms (e.g., Tableau, Power BI, SQL) to support quality reporting and insights is a plus.
Knowledge of cloud services (e.g., AWS, Azure, Google Cloud) and modern data technologies, and PMI/PMP certification, are a plus.

Responsibilities

Owns and matures the quality program framework, including quality controls, sampling strategy, escalation routines, governance cadence, and sustained monitoring.
Establishes and enforces data governance policies to maintain the quality, security, and compliance of the audit findings, file layouts, and reporting artifacts underlying the QA program, serving as an escalation point for data integrity issues and coordinating resolution with the respective teams.
Identifies early quality signals, and client-facing or operational exposure before issues escalate externally, using root cause analysis, trend monitoring, and risk segmentation to determine whether issues are isolated, systemic, or likely to affect our clients.
Partners consultatively with operations, analytics, technology, training, and client-facing leaders to translate quality findings into action.
Develops remediation plans that include containment, ownership, timelines, measurable success criteria, governance checkpoints, and evidence of sustained improvement.
Ensures changes to AI-supported workflows are supported by controlled pilots, release-readiness criteria, risk-based testing, documentation, post-implementation monitoring, and stakeholder alignment.
Champions innovation and responsible use of AI to creatively improve processes and workflows.
Drives continuous improvement by establishing clear accountability, ensuring disciplined execution of quality actions.
Participates in the strategic planning of quality data architecture, reporting processes, and organization at an enterprise level, partnering with analytics, technology, and machine learning teams to enhance quality analytics capabilities and provide actionable business insights.
Communicates emerging risks and remediation progress clearly to senior leadership with appropriate urgency, balance, and action orientation.
Maintains professional relationships across the quality organization and audit enterprise. Identifies opportunities to expand the scope of quality initiatives to create unique value for clients.
Communicates opportunities to Cotiviti Leadership.
Establishes reporting and insights on quality program performance and business patterns utilizing metrics that matter.
Provides People Obsessed leadership by communicating all expectations as well as future goals. Motivates employees by using a combination of individual, team, and department recognition.
Responsible for the operationalization of new quality programs and initiatives. This effort is executed in collaboration with internal stakeholders including but not limited to the CCV Operations and Validation team, content teams, and the Client Service team.
Works closely with the client service team to ensure appropriate execution, monitoring, and maintenance of quality standard.
Works closely with the teams responsible for developing clinical, coding, and quality-related content used across quality program.
Facilitates execution of new concept development and maintenance of existing quality criteria within program tools, and provides program.
Drives high performance and develops strong relationships across a matrixed organization, exhibiting strong organizational leadership internally and externally.
Manages expectations of external stake holders via clear communication with client service managers and business unit leadership.
Grasps internal operational cycles and processes as well as their impact upon delivery.
Understands project scope, schedule, and resources.
Anticipates disconnects and identifies solutions.
Maintains a Deeply Curious mindset to follow projects to drive results and document improvement.