Interview guides · Change Healthcare

Change Healthcare Software Engineer Interview Guide

Change Healthcare Software Engineer interview guide: reported rounds, questions and how candidates describe the process.

The 60-second brief

As a Software Engineer at Change Healthcare, you are at the intersection of complex healthcare data and modern technology. Your work is essential to powering the infrastructure that supports providers, payers, and patients. You are not just writing code; you are building scalable solutions that improve the efficiency and accuracy of healthcare delivery, often dealing with high-stakes environments where reliability and security are paramount. You will likely contribute to a range of projects, from optimizing data processing pipelines to developing user-facing applications. The role demands a balance of technical rigor and a deep understanding of the problem space, as you will collaborate with architects, product managers, and cross-functional teams to solve real-world challenges.

This guide is scoped to a Software Engineer candidate at Change Healthcare.

Focus areas

C#
Coding Interviews (algorithmic whiteboard problem solving)
Threading / Concurrency

The Change Healthcare interview process

Change Healthcare candidates report 3 rounds over 3-5 weeks. The stages below are what candidates describe, not a published process.

Initial Screening

An initial screening with a recruiter to assess your background and fit for the role.

What to demonstrate

An initial screening with a recruiter to assess your background and fit for the role
Depth in C#

How to prepare

Be able to walk your CV end to end in two minutes, and say why this company specifically.
Have your salary expectations, notice period and location constraints ready, and ask for the rest of the loop in writing.

Technical Rounds

One or more technical interviews to evaluate your technical skills and problem-solving abilities.

What to demonstrate

One or more technical interviews to evaluate your technical skills and problem-solving abilities
Depth in C#

How to prepare

Answer aloud and timed: Can you explain your experience with C# or.NET?
Answer aloud and timed: What is your familiarity with threading and asynchronous programming?

Discussion with Hiring Managers

A final discussion with hiring managers or team leads to assess team fit and collaboration.

What to demonstrate

A final discussion with hiring managers or team leads to assess team fit and collaboration
Depth in C#

How to prepare

Prepare two projects you led end to end, each with the decision you owned and what it cost.
Have three questions about the team's roadmap and how success is measured in the first six months.

Where candidates lose points

Communicate your thought process

Always talk through your logic during coding or design problems. Interviewers want to see how you think, not just the final result.

Be honest about your experience

If you don't know an answer, explain how you would go about finding the information. This demonstrates resourcefulness.

Prepare questions for them

Use the interview to learn about their build processes, testing culture, and team structure. This shows you are serious about the quality of your work.

Review your resume

Be prepared to discuss every project or skill you listed in detail.

Questions & practice

What is your familiarity with threading and asynchronous programming?

Medium · Technical and Domain Knowledge

Approach

Say what the runtime actually does before reasoning about the code.
Name what is shared across threads and what owns each piece of state.
Identify the window where an invariant is briefly untrue.
Distinguish a value from a reference to it, and say which one you handed out.

Follow-up

What happens if two callers reach this at the same time?
Where could this allocate more than you expect?

Archive a resource graph without breaking live references or recursing

Medium · graph traversal · topological order · tenant isolation

Resources reference other resources within a tenant; for the largest tenant the reference table holds up to 2,000,000 nodes and 8,000,000 edges. Archiving a resource must archive everything reachable from it that nothing outside the set still references, refuse when a live external referrer exists, and terminate when references form cycles, which they legitimately do. Produce the archive order and the refusal list, targeting O(V+E). Say what stops the traversal crossing a tenant boundary, and why recursion is the wrong control structure at this size.

Approach

Load the subgraph with the tenant predicate on both endpoints of the edge, not only on the side you started from. Scoping the left table alone is the classic cross-tenant leak: one mis-entered edge then pulls another tenant's resources into the traversal and, worse, into the archive.
Traverse iteratively with an explicit stack. A 2,000,000-node graph can hold a chain deep enough to exhaust a native stack in the low tens of thousands of frames, and that failure is a process crash rather than an error you can return.
Treat cycles as data rather than corruption: compute strongly connected components with Tarjan in O(V+E) using its own explicit stack, then condense. The condensation is a DAG, so a topological order over it gives the archive order, and every member of a component archives in one transaction because no order within a cycle is valid.
Decide refusals with reverse edges. A candidate is archivable only if every in-edge originates inside the candidate set, so build the transpose or count in-degrees restricted to the visited set, and emit each blocked resource with the id of the external referrer, which is the only part of the answer an operator can act on.

Follow-up

The graph is read in one query and the archive writes a minute later. What can change in between, and how do you make the write safe?
The candidate set is 400,000 resources. Is that one transaction, and if not, what does a half-finished archive look like to a reader?

Canonicalise a request body into a stable idempotency fingerprint

Medium · parsing · canonicalisation · hashing

idempotency_key.request_fingerprint is a SHA-256 over the method, path and canonicalised body, and a retry whose fingerprint differs must be rejected with 422 rather than served the stored response. Write the canonicaliser. Bodies are JSON up to 256 KB nested at most 32 levels; clients vary key order, whitespace and unicode escaping, and some send 64-bit ids as JSON numbers. Produce a deterministic byte string such that semantically identical bodies match and any semantic difference does not. State your complexity and name two normalisations you refuse to perform.

Approach

Parse once into a tree, then re-serialise under fixed rules: object keys sorted, array order preserved, one escaping convention, no insignificant whitespace. Parsing is O(n) and sorting keys is O(k log k) per object, so O(n log n) overall with O(depth) stack, and the 32-level cap is enforced during parsing because hostile nesting is how a canonicaliser becomes a stack overflow.
Sort keys by their UTF-8 bytes and say why the obvious implementation is wrong in some runtimes: a default string comparison that orders by UTF-16 code units places surrogate pairs, meaning code points from U+10000 up, below U+E000 to U+FFFF, which is not UTF-8 byte order, so two services written in different languages disagree on the same document.
Do not re-encode numbers through a double. IEEE-754 binary64 represents integers exactly only up to 2^53, so normalising a 19-digit id through a float changes it, and 1 against 1.0 cannot be reconciled without deciding whether they are the same value. Preserve the literal token, and require ids as strings at the API boundary if you want them comparable.
Reject duplicate keys rather than picking one. JSON permits them and parsers disagree, most keeping the last, so any choice you make ties the fingerprint to a parser detail that the code handling the request does not necessarily share.

Follow-up

A client sends the same logical request with an extra field your API ignores. Same key, different fingerprint, so you return 422. Is that the right answer?
Where does the fingerprint get computed relative to request decompression and the body-size limit?

Replace offset paging on the resource feed with keyset

Easy · keyset pagination · composite index · sort order

resource holds resource_id, tenant_id, owner_user_id, title, body_ref, version, status ('draft','active','archived','deleted'), created_at, updated_at, deleted_at, with an index on (tenant_id, status, updated_at DESC, resource_id DESC). The listing endpoint returns active resources for one tenant, newest update first, 50 per page, today with LIMIT 50 OFFSET n. Tenants reach page 400 and rows are created while they read. Write the keyset query, define what the cursor carries and how it is encoded, and say which part of the index each predicate uses. Assume PostgreSQL 16.

Approach

Name the two failures separately. OFFSET 20000 makes the server produce and discard 20,000 rows, so page cost grows with depth rather than with page size. Independently, any write that changes how many rows sort above the offset moves the window between two fetches, and the direction decides which anomaly you get: an insert lands at the head of updated_at DESC and pushes already-returned rows down past the boundary, so they are returned a second time; a delete above the offset, or a row whose updated_at is bumped above the cursor, pulls rows up and one is never returned at all. Nothing in the response reveals either.
Write the seek: WHERE tenant_id = $1 AND status = 'active' AND (updated_at, resource_id) < ($2, $3) ORDER BY updated_at DESC, resource_id DESC LIMIT 50. The row-value comparison is one index range rather than a disjunction, and both columns are NOT NULL, which is what makes that comparison well defined.
Map each predicate onto the index: tenant_id and status are equality on the leading columns, (updated_at, resource_id) is the range, and the ORDER BY matches the index order so no Sort node appears and the scan stops after 50 rows. The DESC in the definition only matters for mixed directions — a plain ascending btree on the same columns is read backwards for this query.
Put both sort columns in the cursor and nothing the client can tamper with into another tenant: base64 of (updated_at, resource_id), validated server-side, with tenant_id taken from the principal.

Follow-up

The client asks for 'jump to page 400'. What do you offer instead, and what does the honest version cost?
Sort order becomes user-selectable across four columns. How many indexes is that, and which would you refuse to add?

Stop tag and share joins from fanning out a page

Medium · join fan-out · semi-joins · many-to-many

resource_tag is (resource_id, tag_id) with PK (resource_id, tag_id); resource_share is (resource_id, shared_with_user_id, permission). The tagged-and-shared listing inner-joins resource to both, filters tenant_id, tag_id = ANY($2) and shared_with_user_id = $3, orders by updated_at DESC and takes 50. Pages come back with fewer than 50 distinct resources and the total in the header is far too high. Explain the row multiplication, rewrite both the page query and the count query so each is correct, and name the index each one needs. PostgreSQL 16.

Approach

Do the arithmetic against the predicates that are actually there. An inner join emits one row per matching child row, and both joins are filtered: tag_id = ANY($2) admits only the requested tags, shared_with_user_id = $3 admits one user's share rows. So a resource holding three of the requested tags and shared with $3 once yields three rows, not one — the multiplier is its count of matching tags times its share rows for that single user, and that second factor is 1 unless the table admits duplicate (resource_id, shared_with_user_id) pairs. LIMIT 50 then limits rows rather than resources, and COUNT(*) counts pairs — the header is the product, not the population.
Reject DISTINCT as the fix. It deduplicates after the product has been built, so the planner must materialise and sort the fanned-out set before the LIMIT can apply, and it leaves any SUM or AVG in the same select list wrong.
Rewrite both filters as semi-joins, keeping resource as the only row source: AND EXISTS (SELECT 1 FROM resource_tag rt WHERE rt.resource_id = r.resource_id AND rt.tag_id = ANY($2)) and the same shape against resource_share. A semi-join stops at the first match per resource and preserves the driving index order, so ORDER BY updated_at DESC, resource_id DESC LIMIT 50 still stops after 50 rows.
Count with the same predicates and no join at all: SELECT count(*) FROM resource r WHERE r.tenant_id = $1 AND r.status = 'active' AND EXISTS (...) AND EXISTS (...). Nothing multiplies a resource, so the number is the population.

Follow-up

The filter changes from 'any of these tags' to 'all of these tags'. Rewrite it and state what it costs relative to the ANY form.
A resource can be shared with the same user twice under different permissions. Does your count change, and should it?

What is your favorite programming language and why?

Medium · Technical and Domain Knowledge

Approach

Clarify what is being asked and what a complete answer contains.
State your assumptions explicitly before working the problem.
Say what you would check first and why it is the highest-information step.
Work from the requirement backwards to the design.

Follow-up

What assumption would you test first?
How would you know your answer was wrong?

How do you stay updated with new technologies and industry trends?

Medium · Technical and Domain Knowledge

Approach

Clarify what is being asked and what a complete answer contains.
State your assumptions explicitly before working the problem.
Say what you would check first and why it is the highest-information step.
Work from the requirement backwards to the design.

Follow-up

What assumption would you test first?
How would you know your answer was wrong?

Describe how you would design a system for a vending machine.

Medium · Problem Solving and System Design

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

How would you design a typical web-based system architecture?

Medium · Problem Solving and System Design

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

Can you walk me through a challenging technical problem you solved recently?

Medium · Problem Solving and System Design

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

Explain how you would approach testing for a design you just created.

Medium · Problem Solving and System Design

Approach

Fix the scope first: who calls this, how often, and what they do when it fails.
Name the read and write paths separately; they rarely have the same bottleneck.
Choose a partition key and say what query it makes expensive.
State the consistency you need, and where you are willing to be stale.

Follow-up

What breaks first when traffic grows ten times?
How does this behave when that dependency is down for an hour?

How do you approach debugging complex issues in a distributed system?

Medium · Technical and Domain Knowledge

Approach

Establish what changed and when, before forming any theory.
Pick a bisection that eliminates candidates whichever way it turns out.
Check the instrumentation before believing the symptom.
Separate the trigger from the cause; the deploy is rarely the bug.

Follow-up

What would you look at first, and what would it rule out?
How would you tell a cause from a coincidence here?

Suggested practice checklist

Built from the rounds and topics Change Healthcare candidates report.

Day 1 — Map the Change Healthcare loop

Write out the reported sequence: Initial Screening, Technical Rounds, Discussion with Hiring Managers.
For each round, write one sentence on what it is judging, from the description above, and mark the one you are least ready for.

Deliverable: A one-page map of the 3 reported rounds, with the weakest marked.

Day 2 — Work C#

Spend the session on C#, which Change Healthcare candidates report being tested on.
Write one worked example in C# and time yourself on it.

Deliverable: One timed worked example in C#.

Day 3 — Work Coding Interviews (algorithmic whiteboard problem solving)

Spend the session on Coding Interviews (algorithmic whiteboard problem solving), which Change Healthcare candidates report being tested on.
Write one worked example in Coding Interviews (algorithmic whiteboard problem solving) and time yourself on it.

Deliverable: One timed worked example in Coding Interviews (algorithmic whiteboard problem solving).

Day 4 — Work Threading / Concurrency

Spend the session on Threading / Concurrency, which Change Healthcare candidates report being tested on.
Write one worked example in Threading / Concurrency and time yourself on it.

Deliverable: One timed worked example in Threading / Concurrency.

Day 5 — Answer out loud: Technical and Domain Knowledge

Answer aloud, timed: What is your favorite programming language and why?
Answer aloud, timed: How do you stay updated with new technologies and industry trends?

Deliverable: Spoken answers to 2 reported Technical and Domain Knowledge question(s), under time.

Day 6 — Answer out loud: Problem Solving and System Design

Answer aloud, timed: Describe how you would design a system for a vending machine.
Answer aloud, timed: How would you design a typical web-based system architecture?

Deliverable: Spoken answers to 2 reported Problem Solving and System Design question(s), under time.

Day 7 — Answer out loud: Behavioral and Culture Fit

Answer aloud, timed: Tell me about yourself and your professional journey.
Answer aloud, timed: How do you handle feedback from peers or management?

Deliverable: Spoken answers to 2 reported Behavioral and Culture Fit question(s), under time.

Behavioural preparation

Behavioural rounds judge the decision you made and what it cost.

Can you explain your experience with C# or.NET?

Medium · Technical and Domain Knowledge

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?

How do you handle scenarios where requirements are ambiguous or shifting?

Medium · Problem Solving and System Design

Approach

Pick a story where you made the decision, not one where you watched it.
State the situation in two sentences and spend the rest on the reasoning.
Give the blast radius: what could have broken, and what you measured.
Name the disagreement and how you resolved it with evidence.

Follow-up

What would you do differently if you ran that again?
How did you know your change caused the improvement?