Senior Actuarial Analyst

Summary

Join Cohere Health as a Senior Actuarial Analyst and contribute to our mission of improving patient care through AI-driven clinical intelligence. You will play a key role in identifying and analyzing cost-saving initiatives within our prior authorization process. This senior position demands deep analytical skills, financial modeling expertise, and collaboration with cross-functional teams. You will develop and maintain cost-saving models, prepare insightful reports, and advise leadership on strategic cost reduction strategies. This fast-paced, project-based role offers significant growth opportunities within a rapidly expanding company. The ideal candidate possesses extensive healthcare analytics experience, strong data visualization skills, and a passion for improving the U.S. healthcare system.

Requirements

• Associate of the Society of Actuaries (ASA) required
• 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
• 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

Responsibilities

• Design and maintain complex financial models to track and analyze cost-saving initiatives, providing regular updates and insights to senior leadership and stakeholders
• Perform advanced data analysis to assess prior authorization & claims trends, approval and denial patterns, and cost drivers, focusing on minimizing waste and controlling costs
• 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
• 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
• 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, authorization 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