Lead Actuarial Analyst

Summary

Join Cohere Health's Actuarial Modeling team as a Lead Actuary, focusing on identifying and analyzing cost-saving initiatives within the prior authorization process. This senior role demands deep analytical skills, financial modeling expertise, and collaboration with cross-functional teams. You will develop and maintain cost savings models, prepare reports for senior leadership, and work closely with clinical and customer success teams. The ideal candidate possesses extensive healthcare analytics experience, a strong strategic mindset, and advanced proficiency in Excel and SQL. This fast-paced, project-based role offers significant growth opportunities within a supportive and inclusive environment.

Requirements

• Associate of the Society of Actuaries (ASA) required
• 7+ years of experience in healthcare analytics, cost containment, or similar roles in the healthcare industry, preferably within a payer, provider, managed care, or consulting setting
• Ability to transform complex data into actionable insights and clear, concise reports
• Strong interest and understanding of prior authorization data, claims and SDOH data
• Advanced proficiency in Excel and SQL
• Excellent interpersonal skills to work with internal and external customers
• Passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible
• Self-starter, able to work independently, with drive to succeed in a fast-paced, high-intensity start-up environment

Responsibilities

• Design and maintain financial models to support new sales RFPs, analyze and forecast cost-saving initiatives, while providing regular updates and insights to senior leadership
• Perform advanced data analysis to assess prior authorization & claims trends, approval and denial patterns, and cost drivers, focusing on maximizing customer ROI
• Prepare detailed and executive-level reports and presentations that summarize cost-saving performance, including developing financial projections and providing insight into future cost-saving potential
• 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
• Engage in customer meetings to communicate Cohere’s value proposition
• 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
• Create and update documentation on analytical methodologies, workflows, and reporting protocols for internal and external use

Preferred Qualifications

Familiarity with prior authorization, utilization management processes is highly desirable

Benefits

• Health insurance
• 401k
• Bonus