Senior Healthcare Analyst, Actuarial

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 LinkedIn™ 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

We are looking for a detail-oriented and analytical Senior Healthcare Analyst to join our Actuarial team. The Senior Healthcare Analyst will be responsible for identifying, analyzing the cost-saving initiatives that enhance the efficiency and effectiveness of the prior authorization process. This senior role involves deep analytical work, cost savings model development, collaboration with cross-functional teams (clinical strategy, product and customer success teams), and strategic recommendations aimed at reducing unnecessary spending, optimizing resources, and ensuring compliance with clinical and regulatory standards. The ideal candidate will have extensive experience in healthcare analytics, financial modeling, and prior authorization, along with a strong strategic mindset and data-driven problem-solving skills. The work will be fast-paced and project-based, with evolving needs - requiring scrappiness, flexibility, curiosity, and grace under pressure.

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 opportunity. You will be part of the Actuarial team and develop & maintain cost savings models.

 What you will do:

• Cost Savings Analysis & Reporting
  
  • Perform advanced data analysis to assess prior authorization & claims trends, approval and denial patterns, and cost drivers, focusing on minimizing waste and controlling costs.
  • Design and maintain complex financial models to track and analyze cost-saving initiatives, providing regular updates and insights to senior leadership and stakeholders.
  • Lead the design and development of financial models to quantify the impact of proposed cost-saving initiatives and forecast cost reduction outcomes for business cases.
  • Use statistical and data visualization tools to identify trends, patterns, and anomalies in authorization data that may indicate areas for improvement on savings.
  • Prepare detailed and executive-level reports and presentations that summarize cost-saving achievements, project performance, and future cost-saving potential.

• Stakeholder Collaboration
• Act as a trusted advisor to leadership and key internal & external stakeholders, providing strategic insights, recommendations, and guidance on cost-saving strategies.
• Work closely with clinical and customer success teams to understand authorization challenges, provide analytical insights, and offer actionable recommendations to resolve issues.
• Continuous Improvement
• Identify and implement innovative approaches to further optimize cost savings, including the adoption of new technologies, data analysis tools, and process improvements.
• Lead post-implementation assessments to measure the impact of cost-saving initiatives, ensuring continuous refinement and long-term sustainability of improvements.
• Training & Documentation
• Create and update documentation on analytical methodologies, authorization workflows, and reporting protocols for internal and external use.

Your background & requirements: 

• 5-8 years of experience in healthcare analytics, cost containment, or similar roles in the healthcare industry, preferably within a payer, provider, or managed care setting.
• Familiarity with prior authorization, utilization management processes is highly desirable.
• Strong understanding of healthcare cost drivers, claims data, and prior authorization processes.
• Strong data interpretation, statistical analysis and problem-solving skills 
• Ability to transform complex data into actionable insights and clear, concise reports.
• Proficiency in data analytics and visualization tools, such as SQL, Tableau, Power BI, and advanced Excel.
• Strong interest and understanding of prior authorization data, claims and SDOH data
• Proficient in R, SQL, Python, Scala, AWS (S3, Airflow, Athena, Spark) 
• Excellent interpersonal skills to work with end users to develop QC metrics
• 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

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 $100,000 to $115,000 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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