Senior Manager, Actuarial Modeling & Experience Studies

Summary

Join Cohere Health as a Senior Manager, Actuarial and lead the development and execution of comprehensive cost savings and experience study models. You will establish an infrastructure for evaluating the financial impact of Cohere’s programs, demonstrating value to customers. Collaborate with operational analytics, clinical, and data teams to ensure model accuracy. This role involves designing and improving models, supporting strategic growth, mentoring analysts, and maintaining documentation. The ideal candidate possesses extensive actuarial experience, leadership skills, advanced data analysis capabilities, and excellent communication skills. This position offers significant 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

• Build and Implement Comprehensive Cost Savings Models: Develop robust, multi-faceted models, including activity-based and direct claims-based approaches, to evaluate Cohere’s impact on both gross and incremental savings. Models will account for sentinel effects, risk adjustments, and other critical factors to ensure an accurate and consistent valuation of Cohere’s value for customers, supporting satisfaction and retention
• Leadership and Team Development: Establish and lead the actuarial function to support model development and experience studies to set key assumptions to our model and help the company to understand key product performance and obtain insights. Work collaboratively with the customer-facing cost savings team to ensure that model outputs are integrated effectively into daily operations
• Model Development and Research: Design and continuously improve models that accurately measure the sentinel effect of Cohere’s interventions on provider behavior and patient outcomes. Adjust for population risk, unit cost trends, and utilization patterns, ensuring the model aligns with industry standards
• Growth Opportunity Modeling: Support Cohere’s strategic growth by developing models that evaluate the financial potential of new specialty categories and expanded program offerings. Provide data-driven insights to support business expansion beyond utilization management
• Mentorship and Model Maintenance: Guide actuarial analysts in maintaining, enhancing, and reviewing financial models to ensure ongoing accuracy, relevance, and adaptability
• Methodology Documentation: Maintain comprehensive documentation of methodologies, trends, impact evaluations, and coding for all analytic files and models. Ensure scalability and readiness to support multiple programs, services, care pathways, and lines of business, including Medicare Advantage, commercial, and Medicaid

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