Senior Manager Quality Audit Operations

Cotiviti•Remote,

1d•Remote

About The Position

The Senior Manager, Quality Assurance leads a team of quality-focused individuals across multiple review types responsible for developing, executing, and continuously improving CCV’s quality assurance programs, and ultimately, delivering value to our clients. This leader oversees the governance of quality standards, criteria, audit guidelines, and monitoring processes to ensure programs are evaluated, maintained, and refined over time. The Senior Manager is responsible for ensuring the accurate application of audit guidelines applied through AI-supported and human-reviewed processes, to support high audit accuracy, consistent and sustainable review outcomes, and reliable identification of quality opportunities. 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 AI-supported and human-reviewed workflows. 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.

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.
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 a dedicated, secure work area.
Must be able to provide high-speed internet access / connectivity and office setup and maintenance.

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.

Responsibilities

Owns and matures the quality program framework, including quality controls, sampling strategy, escalation routines, governance cadence, and sustained monitoring.
Defines, measures, and monitors accuracy, consistency, and decision quality across AI-supported and human-reviewed workflows.
Identifies early quality signals, accuracy drift, 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 audit performance, increase review effectiveness, strengthen quality insights, and identify scalable opportunities to improve accuracy, productivity, risk detection, and client value.
Drives continuous improvement by establishing clear accountability, ensuring disciplined execution of quality actions, and positively influencing auditor and audit behavior through data-driven coaching, feedback loops, reinforcement of expectations, and sustained monitoring of outcomes. 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.
Ensures that QA productivity goals and standards set are consistently met or exceeded. Removes roadblocks to great performance.
Monitors team coverage of responsibilities to assist with redistribution of work as necessary to achieve set targets.
Promptly addresses and resolves issues impacting productivity.
Builds trust, respect and an engagement through communication and positive reinforcement to create a tradition of maintaining and exceeding internal and external expectations.
Strives to continuously Build Better.
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 Validiti team, content teams, and the Client Service team.
Works closely with the client service team to ensure appropriate execution, monitoring, and maintenance of quality standards.
Works closely with the teams responsible for developing clinical, coding, and quality-related content used across quality programs.
Facilitates execution of new concept development and maintenance of existing quality criteria within program tools, and provides program oversight.
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.
Hire, develop, coach, lead and retain top-tier talent, with a focus on building and improving a team and culture that is able to assist in employing best in class practices to support and drive high levels of internal and external customer satisfaction.
Complete all responsibilities as outlined in the annual performance review and/or goal setting.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.
This job description is intended to describe the general nature and level of work being performed and is not to be construed as an exhaustive list of responsibilities, duties and skills required. This job description does not constitute an employment agreement and is subject to change as the needs of Cotiviti and requirements of the job change.