Senior Healthcare Analyst, Actuarial

Summary

Join Cohere Health's Actuarial team as a Senior Healthcare Analyst. You will leverage your analytical skills to identify and analyze cost-saving initiatives within the prior authorization process. This role demands deep analytical work, financial modeling, collaboration with cross-functional teams, and strategic recommendations to reduce unnecessary spending. 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 experience in healthcare analytics, financial modeling, and prior authorization, along with strong problem-solving and communication skills. This fast-paced, project-based position offers significant growth opportunities within a thriving company.

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
• 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

• 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
• 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