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Lead Actuarial Analyst, Core UM Impact Reporting

2 months ago

Remote, Oregon, United States Cohere Health Full time

Company Overview:

Cohere Health is a fast-growing clinical intelligence company that's improving lives at scale by promoting the best patient-specific care options, using leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, while our revenues and company size have quadrupled. That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work, Top 5 LinkedInTM Startup, TripleTree iAward, multiple KLAS Research Points of Light, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

The Lead Actuarial Analyst will help drive Cohere's processes for ensuring the sound actuarial evaluation and sizing of savings for clients. This role will be highly visible, working closely with our cross-functional & client-facing teams throughout the evaluation cycle.

At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunities.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What you will do:

  • Quickly understand Cohere's products, services and clinical programs and how Cohere's x-functional collaboration and workflow intersect with healthcare providers' workflow and patients' care journey.
  • Leverage data from various sources, e.g., medical claims and data submitted by providers via the prior authorization process, working with Directors of Clinical Programs & Actuarial Teams to evaluate expected Cohere performance and ROI, e.g., saved medical cost, saved administrative cost and improved quality and patient outcomes, for proposed clinical programs and interventions to inform strategic planning.
  • Evaluation of ROI in clinical programs across prospective & existing clients, and collaborate with clinicians, finance, data science, and growth teams to enhance Cohere's capabilities to size & underwrite opportunities.
  • Lead the impact performance presentation to clients and provide the clinical insights.
  • Guide actuarial analysts in maintenance, enhancement and review of financial models
  • Maintain documentation of methodology of trend analysis/impact evaluation analysis and coding/programs of all analytic file building and actuarial analysis and models so they are ready to quickly scale to multiple programs and interventions across types of services, care paths/diagnosis groups and lines of business (e.g., Medicare Advantage, commercial Medicaid).

Your background & requirements:

  • Passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible.
  • 7+ years of professional experience in a health actuarial role (payer, provider, consulting), with experience in pricing, analyzing medical trend, financial modeling, and/or evaluating trend management & health intervention programs.
  • Advanced knowledge of observation data analyses with large datasets including medical, provider, member, pharmacy, and eligibility data – including familiarity with working with claims at the code level (ICD-10, DRG, CPT/HCPCS, revenue codes).
  • Self-starter, able to work independently, able to succeed in a fast-paced, high intensity start-up environment.
  • Excellent communication skills, with proven ability to create & deliver the results of analyses to non-technical audiences.
  • Bachelor's Degree in Math, Statistics, Biostatistics, Actuarial Science, or Economics required.
  • SQL experience required, Python / R is a plus
  • Associate of the Society of Actuaries (ASA)

Please Note: We offer a continuing education program for all Actuarial Analysts.

This program includes:

  • Bonus and salary increase upon successful completion of your ASA or FSA
  • Reimbursements for required books and first attempt exam fee
  • Company would reimburse the annual actuarial credential licensing fees
  • Flexible PTO policy to accommodate the SOA exams

We can't wait to learn more about you and meet you at Cohere Health

Equal Opportunity Statement:

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all. To us, it's personal.

The salary range for this position is $120,000 to $140,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

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