Lead Actuarial Analyst, Health Economics Opportunity Sizing

at  Cohere Health

COMPANY OVERVIEW:

Cohere Health is illuminating healthcare for patients, their doctors, and all those who are important in a patient’s healthcare experience, both in and out of the doctors office. Founded in August, 2019, we are obsessed with eliminating wasteful friction patients and doctors experience in areas that have nothing to do with health and treatment, particularly for diagnoses that require expensive procedures or medications. To that end, we build software that is expressly designed to ensure the appropriate plan of care is understood and expeditiously approved, so that patients and doctors can focus on health, rather than payment or administrative hassles.

YOUR BACKGROUND & REQUIREMENTS:

• Passionate about improving the U.S. healthcare system and helping ensure every patient receives the best care possible.
• 5+ years of professional experience in a health actuarial role (payer, provider, consulting), with experience in pricing, analyzing medical trend, financial modeling, and/or evaluating trend management & health intervention programs.
• Advanced knowledge of observation data analyses with large datasets including medical, pharmacy, and eligibility data – including familiarity with working with claims at the code level (ICD-10, DRG, CPT/HCPCS, revenue codes).
• Self-starter, able to work independently, able to succeed in a fast-paced, high intensity start-up environment.
• Excellent communication skills, with proven ability to create & deliver the results of analyses to non-technical audiences.
• Bachelor’s Degree in Math, Statistics, Biostatistics, Actuarial Science, or Economics required.
• SQL experience required, Python / R is a plus
• Associate of the Society of Actuaries (ASA)
  Please Note: We offer a continuing education program for all Actuarial Analysts.

This program includes:

• Bonus and salary increase upon successful completion of your ASA or FSA
• Reimbursements for required books
• Company paid annual licensing fees
• Flexible PTO policy for your exams

• Quickly understand Cohere’s products, services and clinical programs and how Cohere’s x-functional collaboration and workflow intersect with healthcare providers’ workflow and patients’ care journey.
• Leverage data from various sources, e.g., medical claims and data submitted by providers via the prior authorization process, working with Directors of Clinical Programs & Actuarial Teams to evaluate expected impact and ROI, e.g., saved medical cost, saved administrative cost and improved quality and patient outcomes, for proposed clinical programs and interventions to inform strategic planning.
• Evaluation of ROI in clinical programs across prospective & existing clients, and collaborate with clinicians, finance, data science, and growth teams to enhance Cohere’s capabilities to size & underwrite opportunities
• Guide actuarial analysts in maintenance, enhancement and review of financial models
• Maintain documentation of methodology of trend analysis/impact evaluation analysis and coding/programs of all analytic file building and actuarial analysis and models so they are ready to quickly scale to multiple programs and interventions across types of services, care paths/diagnosis groups and lines of business (e.g., Medicare Advantage, commercial Medicaid).