Senior Actuarial Manager

Summary

Join Cohere Health, a rapidly growing clinical intelligence company, as a Senior Actuarial Manager. Lead the development and execution of cost-saving models and clinical analytics. Build a robust actuarial infrastructure to evaluate the financial impact of Cohere’s programs. Collaborate with internal and external stakeholders to support strategic growth initiatives. This role requires extensive actuarial experience, leadership skills, and advanced data analysis capabilities. You will mentor a team and ensure models are accurate, scalable, and adaptable. This position offers exponential growth opportunities within a supportive and inclusive environment.

Requirements

• Passion for Healthcare Transformation: Committed to improving the U.S. healthcare system, with a focus on ensuring patients receive high-quality, cost-effective care
• Extensive Actuarial Experience: 8+ years in a health actuarial role within payer, provider, or consulting settings, with demonstrated expertise in pricing, medical trend analysis, financial modeling, and evaluating trend management or health intervention programs
• Leadership Experience: Proven leadership skills, with experience managing, mentoring, or guiding team members. Ability to lead projects and collaborate cross-functionally with analytics, clinical, and data engineering teams to drive impactful outcomes
• Big-Picture Thinker with Strategic Insight: Ability to see beyond immediate tasks and understand the broader impact of actuarial models on business goals and customer outcomes. Capable of developing models that align with long-term strategic objectives and market trends
• Advanced Data Analysis Skills: Deep experience in observational data analysis with large datasets, including claims data (ICD-10, DRG, CPT/HCPCS, revenue codes), and a high level of proficiency working with medical, provider, member, pharmacy, and eligibility data
• Independent and Self-Driven: A self-starter who excels in a fast-paced, high-intensity start-up environment, with the ability to work autonomously and manage multiple projects effectively
• Excellent Communication Skills: Proven ability to translate complex actuarial analysis into actionable insights for non-technical audiences, with strong presentation and report-writing skills
• Educational Background: Bachelor’s Degree in Math, Statistics, Biostatistics, Actuarial Science, or Economics required
• Technical Proficiency: SQL and advanced Excel experience is required; proficiency in Python or R is a plus
• Professional Credentialing: Associate of the Society of Actuaries (ASA) designation required; Fellow of Society of Actuaries (FSA) is a plus

Responsibilities

• Develop and Implement Comprehensive Cost Savings Models
• Build robust, multi-faceted actuarial models to quantify Cohere’s impact on both gross, net and incremental savings, leveraging activity-based and claims-based approaches
• Incorporate sentinel effects, risk adjustments, unit cost trends, and utilization patterns to ensure precise and consistent valuation of Cohere’s value to customers, supporting satisfaction, retention, and business growth
• Lead Pricing, Experience Studies, and Assumption Development
• Conduct experience studies to refine key assumptions and enhance the accuracy of pricing and cost-saving projections
• Collaborate with customer-facing cost savings teams to integrate model outputs into operational workflows, ensuring data-driven decision-making
• Drive Model Integration and Automation
• Translate actuarial methodologies into IT system requirements to streamline automation and enhance model efficiency
• Support the development of cloud-based dashboards, ensuring accurate, scalable, and user-friendly reporting
• Advance Model Development and Research
• Continuously refine models to measure Cohere’s impact on provider behavior and patient outcomes through sentinel effect analysis
• Align models with industry standards, adjusting for population risk, pricing trends, and utilization patterns
• Support Strategic Growth and Business Expansion
• Develop growth opportunity models to assess the financial potential of new specialty categories and expanded program offerings
• Provide data-driven insights to support business expansion beyond utilization management
• Mentor, Maintain, and Optimize Actuarial Models
• Guide and mentor actuarial analysts in maintaining, enhancing, and reviewing financial models for accuracy and relevance
• Ensure models are scalable and adaptable to multiple programs, care pathways, and payer segments (Medicare Advantage, Commercial, Medicaid, etc.)
• Ensure Methodology Transparency and Scalability
• Maintain comprehensive documentation of methodologies, impact evaluations, and coding to ensure reproducibility and scalability
• Align documentation to support a standardized actuarial approach across all programs and stakeholders

Preferred Qualifications

• Proficiency in Python or R
• Fellow of Society of Actuaries (FSA)

Benefits

• 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
• Health insurance
• 401k
• Bonus