Ric Sinclair is the CEO of Cotiviti, an enterprise healthcare software and data company that serves hundreds of health plans — including the top 25 in the country — across payment integrity, interoperability, risk adjustment, value-based care, and member engagement, touching coverage for over 300 million patients and members. Cotiviti pairs algorithms and AI with thousands of clinical nurses, MDs, and content experts in a human-in-the-loop model, working across the full administrative ecosystem that moves between payers, providers, patients, and pharma. Ric's core conviction is that healthcare's central problem isn't a data problem or a technology problem — it's a coordination problem, and what the system has never had is a true infrastructure layer to tie it together. Cotiviti isn't trying to pick a side between payers and providers; the bet is that a neutral party sitting in the middle can drive fair, transparent outcomes and pull down the trillion-plus dollars of administrative waste in U.S. healthcare.
We discuss:
Why healthcare's core problem isn't a data problem or a technology problem — it's a coordination problem, and what it actually takes to build the first infrastructure layer the system has ever had
The real difference between owning a decade of data assets (and the Edifecs integration) and becoming the infrastructure the industry runs on — and where Cotiviti is in that build today
How "human in the loop" works at scale — pairing AI with thousands of nurses, MDs, and content experts so every claim is reviewed fairly and problems get predicted before they happen
Why Ric's answer to AI isn't "cut the 10-person team to 2" — it's "take all 10 and do what 50 could," and what that augment-don't-replace math means for client ROI
How you build trust and accountability into an AI workflow rather than bolting it on — and who's accountable when models start shaping decisions about claims and care
How to sit in the neutral middle between payers and providers who don't trust each other — and what it takes to build something both sides actually believe is fair
What Ric learned as a working drummer in Nashville before healthcare found him — leading without the spotlight, making others better, and why simplicity is a discipline that transfers straight into business
What a truly differentiated healthcare platform looks like five years out — and the test Ric uses for what "winning" means: a family of five at the dinner table who never have to think about the administrative machinery behind their care
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Brought to you by: Sage Growth Partners — Value-focused strategy and marketing for growth-driven healthcare organizations.
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