Senior BRMS Rule Architect - Healthcare Analytics

Cotiviti; United States; Remote; USD 85,000 - 105,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Disability insurance

Life insurance

401(k) savings plan

Paid family leave

Holidays

Job summary

Cotiviti is seeking a Senior Technical Specialist to lead rule intake, design, and deployment for BRMS-based platforms. You will partner with RCA, Implementations, Audit Operations, and R&D to ensure scalable, accurate rule performance and thorough documentation.

You will analyze root causes, improve rule quality, and drive data-driven improvements while coordinating with operations and stakeholders. Strong coding, healthcare domain knowledge, and tools proficiency are required.

Qualifications

• High school diploma required.
• Bachelor’s degree in education, technical writing, communications, or related fields strongly preferred; equivalent experience considered.
• Experience in healthcare industry.
• Basic coding skills: SQL, Java, or similar languages.
• Familiarity with tools such as Access, HUE, Datameer, Power BI, or SSMS.
• Experience with complex business rules, e.g., DROOLS in RedHat Decision Manager.
• Experience in analyzing large datasets and auditing payment inaccuracies.
• Able to work independently and with others to meet outcomes.
• Strong analytical, problem-solving, organization, and communication skills.

Responsibilities

• Receive business rules from Cotiviti teams.
• Clarify intent and context of each rule with partners.
• Design and develop rule logic for BRMS integration.
• Test and validate rules in non-production environments.
• Deploy validated rules to production environments.
• Communicate rule deployment outcomes to stakeholders.
• Maintain documentation and version history for rules.
• Perform impact analysis for new or revised rules.
• Identify gaps where rules don’t deliver intended results.
• Propose corrective actions to improve rule effectiveness.
• Identify technical limitations and performance constraints.
• Lead exclusions functionality design to reduce noise.
• Collaborate with operations to socialize rules and gather feedback.
• Develop reporting on rule effectiveness and audit outcomes.
• Explore automation and workflow enhancements (Power Automate, JIRA, Asana).
• Transition support tasks to downstream teams as appropriate.
• Complete responsibilities per annual Performance Plan.
• Complete special projects as assigned.

Skills

Coding basics

SQL/Java

Analytical thinking

Communication skills

Organizational skills

Education

Bachelor’s degree in education/technical writing/communications

Tools

Access

HUE

Datameer

Power BI

SSMS

Job description

Cotiviti is seeking a Senior Technical Specialist to lead rule intake, design, and deployment for BRMS-based platforms. You will partner with RCA, Implementations, Audit Operations, and R&D to ensure scalable, accurate rule performance and thorough documentation.

You will analyze root causes, improve rule quality, and drive data-driven improvements while coordinating with operations and stakeholders. Strong coding, healthcare domain knowledge, and tools proficiency are required.