[Hiring] Senior Manager Quality Audit Operations @Cotiviti

Role Description

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.

Responsibilities

• AI-Enabled Quality Program Governance
  • 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.
  • 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.
  • Drives continuous improvement by establishing clear accountability, ensuring disciplined execution of quality actions, and positively influencing auditor and audit behavior.
  • Communicates emerging risks and remediation progress clearly to senior leadership with appropriate urgency, balance, and action orientation.
• Relationship Management
  • 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.
• Productivity Management
  • 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 engagement through communication and positive reinforcement.
  • Strives to continuously Build Better.
• Leadership
  • 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.
  • Works closely with the client service team to ensure appropriate execution, monitoring, and maintenance of quality standards.
  • Facilitates execution of new concept development and maintenance of existing quality criteria within program tools.
• Project Management
  • Manages expectations of external stakeholders via clear communication with client service managers and business unit leadership.
  • Grasps internal operational cycles and processes as well as their impact upon delivery.
  • Anticipates disconnects and identifies solutions.
  • Maintains a Deeply Curious mindset to follow projects to drive results and document improvement.
• Additional Responsibilities
  • Hire, develop, coach, lead and retain top-tier talent.
  • 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.

Qualifications

• Bachelor’s degree in related field required; Bachelor’s degree with a quality, healthcare, or analytical focus preferred.
• 3+ years of technical leadership experience: people and projects.
• AI-native experience using generative AI applications.
• AI accuracy mindset: understanding of validation, exception review, quality drift, and human-in-the-loop controls.
• Proven experience influencing behavior, reinforcing expectations, and driving adoption of process improvements.
• Remediation execution: builds practical remediation plans with clear owners and milestones.
• Executive communication: able to communicate complex quality and risk concerns concisely.
• Advanced knowledge of Excel (Pivot Tables, Macros, V Lookups, advanced written formulas).
• Strong analytical and problem-solving ability.
• Organizational skills and attention to detail.
• Excellent written and verbal communication skills.
• Experience in a HIPAA-regulated environment.
• Ability to work well independently and in a team environment.
• Ability to mentor staff and enhance performance.

Requirements

• Experience with quality management methodologies (e.g., Six Sigma, Lean, or CAPA) is a plus.
• Experience developing or maintaining quality assurance programs is a plus.
• Knowledge of medical reimbursement/payment policies, audit review methodologies, and medical terminology is a plus.

Benefits

• 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.