Senior Technical Specialist (Healthcare)

Overview 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. 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