Senior Technical Specialist (Healthcare)

Cotiviti•Remote,

6d•$85,000 - $105,000•Remote

About The Position

The Senior Technical Specialist will collaborate closely with the RCA - Content & Enablement Department, the Implementations Team, and the Audit Operations and R&D teams. This role is responsible for the intake, logic development, deployment, and maintenance of Business Rules that support RCA’s platform applications. The Specialist will also lead efforts to identify and remediate technical limitations, design advanced exclusions logic, and support operational scalability through strategic rule development. In addition to driving rule implementation, the Senior Technical Specialist will act as a key liaison between the operations team and the BRMS Center of Excellence—ensuring strong alignment with end-user needs—and will maintain comprehensive documentation, impact analysis, and reporting for all rule activity. This role supports continuous improvement by conducting root cause and gap analyses to identify where rules are not producing the intended outcomes, and by developing data-driven solutions to optimize performance.

Requirements

High School Diploma Required.
Experience in healthcare industry.
Basic Coding Skills: Understanding of basic programming languages and ability to write and understand code in SQL, Java, or other.
Familiarity with tools such as Access, HUE, Datameer, Power BI, or SQL Server Management Studio (SSMS).
Experience with complex business rules: Familiarity with products like DROOLS in RedHat Decision Manager.
Experience in analyzing large datasets and auditing payment inaccuracies.
Ability to work independently, but also to communicate and collaborate with others to meet desired outcomes.
Excellent analytical and problem-solving skills and ability to manage multiple assignments simultaneously while meeting deadlines and quality standards.
Excellent organization, communication, and presentation skills.
Flexible and able to work in different shifts as per the work requirement.
Strong working experience with Microsoft suite of applications (Word, Excel, PowerPoint, Visio, Outlook)
Troubleshooting: The ability to diagnose and solve complex technical issues, often under pressure. Technical Specialists must quickly identify the root cause of problems and find effective solutions.
Critical Thinking: Specialists are expected to assess a situation, evaluate possible solutions, and make decisions based on logic and data analysis, rather than assumptions or intuition.
Complex Analysis: Some technical problems require the specialist to break down complicated systems or data into manageable parts to analyze and understand them.
Industry-Specific Knowledge: A deep understanding of the specific technologies, systems, or products relevant to the role. This could range from IT systems and programming languages to mechanical engineering or network architecture.
Systems Thinking: Understanding how different components of a system interact with each other and being able to foresee how changes to one part of the system may affect others.
Pattern Recognition: Identifying patterns in complex data or recurring problems to develop effective solutions, both in day-to-day tasks and long-term projects.
Prioritization: The ability to determine which technical issues are the most pressing and need immediate attention versus those that can be addressed later, often in high-pressure environments.
Empathy and Patience: In cases where the technical specialist interacts directly with customers, the ability to listen carefully, understand concerns, and provide solutions in a way that’s considerate of the customer’s needs is important.
Clear Explanations: A mindset of simplifying complex technical issues and presenting them in a way that the customer or user can understand.

Nice To Haves

Bachelor’s degree in education, technical writing, communications, or related fields strongly preferred. Equivalent experience may be considered in lieu of a degree.

Responsibilities

Receive business rules from various internal Cotiviti teams.
Collaborate with internal partners to clarify the intent and context of each rule.
Design and develop rule logic for integration into the Business Rules Management System (BRMS).
Conduct testing and validation of rules in non-production environments to verify accuracy.
Implement validated rules into production environments.
Communicate rule deployment outcomes and changes to operations and key stakeholders.
Maintain and update documentation and version history for all business rules.
Perform impact analysis for newly implemented or revised rules.
Conduct root cause analysis and identify gaps where rules are not delivering intended audit or operational results.
Recommend and implement corrective actions to improve rule effectiveness and alignment with business goals.
Identify and remediate technical limitations and performance constraints related to rule processing.
Lead the design and integration of additional exclusions functionality to improve rule quality and reduce noise.
Partner closely with operations teams to socialize rules, gather user feedback, and ensure alignment with business workflows.
Develop reporting and insights on rule effectiveness, audit outcomes, and content trends.
Explore automation and workflow enhancements, including integration with tools like Power Automate, JIRA, and Asana.
Identify opportunities to transition operational support, training, or documentation tasks to the appropriate downstream teams (e.g., Production Support, EXACT Training Team).
Complete all responsibilities as outlined in the annual Performance Plan.
Complete all special projects and other duties as assigned.
Must be able to perform duties with or without reasonable accommodation.