Redefine Healthcare With Us.

Define Ventures Partners

Sr. Actuarial Analyst, Utilization Management Trend & Impact

Cohere Health

Cohere Health

Posted on Saturday, July 29, 2023

Company Overview:

Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved so that patients and doctors can focus on health, rather than payment or administrative hassles.

Opportunity Overview:

This is an excellent opportunity for an outstanding data analyst to join a Series B digital health company. You will work closely with solution and client specialists, clinicians, program implementation and operation experts, informaticists, data scientists, and actuaries to produce client-facing reports for utilization management impact, savings evaluation, and trend monitoring. These reports will demonstrate to internal and external stakeholders that Cohere clinical programs improve a) payor/provider/patient collaboration through utilization management and care management process, b) quality of care and patient outcomes, and c) healthcare utilization and spending efficiency. The work will be fast-paced and project-based, with evolving needs requiring adaptability, curiosity, and grace under pressure.

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 cross-functional collaboration and workflow intersect with healthcare providers’ workflow and patients’ care journey.
  • Design and execute actuarial models and generate client facing deliverables, including
    • Leveraging data from various sources, e.g., Medical claims and data submitted by providers via the prior authorization process, to analyze and simulate expected impact and ROI, e.g., avoided medical costs, saved administrative cost and improved quality and patient outcomes, for proposed clinical programs and interventions to inform strategic planning.
    • Utilization and spending trend monitoring including forecasting and benchmark setting, by LOB, speciality, patient and provider cohort
  • Address internal and external stakeholders’ investigatory and exploratory trend and impact analyses
  • Present UM trend and impact models and insights to internal and external stakeholders on a regular basis
  • Coordinate analytics activities across multiple projects simultaneously
  • Work collaboratively with internal and external teams to deliver high-quality, on-time results

Your background and requirements:

  • Passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible.
  • Self-starter, able to work independently, able to succeed in a fast-paced, high intensity start-up environment
  • Minimum 7 years of professional experience in an actuarial analytics role within healthcare (payer experience required), with demonstrated analytical and actuarial modeling skills
  • Advanced knowledge of observational data analyses with large data including medical claims, pharmacy, and eligibility data
  • Minimum 7 years of experience using SQL or Python or equivalent statistical and analytical softwares
  • Experience and knowledge of Tableau, Kibana (or similar BI tool) preferred
  • Bachelor’s Degree in Math, Statistics, Biostatistics, Actuarial Science, or Economics required. Advanced degree preferred
  • Successful completion of at least 4 or more SOA Actuarial exams, ASA or FSA preferred.

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.