Senior Solutions Consultant - Retrospective Risk Adjustment

The Solution Consultant for Retrospective Risk Adjustment serves as Cotiviti's subject matter expert and "voice of product" in the field for our retrospective risk adjustment solutions. This role partners directly with Sales teams to drive complex deal pursuits, deliver product demonstrations, support RFP responses, and provide deep technical expertise during customer engagements. The Solution Consultant also serves as a critical feedback channel, bringing market intelligence and customer insights back to Product Management to inform roadmap decisions.

Pre-Sales Support & Customer Engagement

Partner with Sales on strategic opportunities involving retrospective risk adjustment solutions.
• Lead product demonstrations and technical deep-dives for prospective and existing customers.
• Present Cotiviti's retrospective risk adjustment capabilities to health plan executives and operational leaders.
• Support discovery sessions to understand customer challenges, workflows, and requirements.
• Participate in customer site visits and executive presentations for strategic accounts.

RFP & Proposal Support

• Develop and maintain technical content for retrospective risk adjustment RFP responses.
• Collaborate with Sales, Product, and Legal to craft compelling and accurate proposal responses.
• Present solutions during finalist presentations and orals.
• Support pricing discussions with technical validation of scope and delivery approach.

Market Intelligence & Product Feedback

• Capture and synthesize customer feedback, competitive intelligence, and market trends.
• Communicate product gaps, enhancement requests, and market needs to Product Management.
• Participate in product roadmap discussions to ensure alignment with market demands.
• Contribute to competitive battlecards and sales enablement materials.

Subject Matter Expertise

• Maintain deep expertise in Medicare Advantage retrospective risk adjustment operations
• Stay current on CMS-HCC model changes, RADV audit requirements, and industry best practices
• Understand the end-to-end retrospective risk adjustment workflow: chart retrieval, coding, analytics, and submission
• Develop training materials and conduct internal enablement sessions for Sales teams

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.

• Bachelor's degree in Healthcare Administration, Business, or related field
• 10+ years of experience in healthcare technology, risk adjustment operations, or health plan consulting
• Deep knowledge of Medicare Advantage retrospective risk adjustment programs and operations
• Experience in pre-sales, solution consulting, or customer-facing product roles
• Strong presentation and demonstration skills with executive audiences
• Ability to translate complex technical capabilities into business value propositions
• Excellent written communication skills for RFP responses and technical documentation
• Willingness to travel up to 25% for customer meetings and industry events

Preferred Qualifications

• Prior role in health plan risk adjustment or revenue optimization operations
• Familiarity with medical record retrieval, HCC coding, and encounter data submission
• Understanding of Commercial and Medicaid risk adjustment models
• Experience with healthcare analytics platforms and data visualization to

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 proprieties 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.

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 team members a competitive benefits package to address a wide range of personal and family needs, including medical, dental, vision, disability, and life insurance coverage, 401(k) savings plans, paid family leave, 9 paid holidays per year, and 17-27 days of Paid Time Off (PTO) per year, depending on specific level and length of service with Cotiviti. For information about our benefits package, please refer to our Careers page.

Date of posting: 2/18/2026

Applications are assessed on a rolling basis. We anticipate that the application window will close on 4/18/2026, but the application window may change depending on the volume of applications received or close immediately if a qualified candidate is selected.

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