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.

Opportunity overview

Cohere’s Clinical Programs arm of the Clinical Content team is responsible for identifying clinical programs to drive adherence to Cohere’s Care Paths (i.e. our model for ensuring provider decisions are aligned with standards of care and that drive optimal outcomes for every patient). When these programs are implemented successfully, we are able to improve patient experience, clinical quality, provider experience, and achieve the value objectives expected of our clients.   

The Actuarial Analyst will be working closely with Cohere’s Director of Clinical Programs and Quality Analytics and the analytics team and responsible for rapid-cycle monitoring and evaluating the impact of Cohere’s products, services and clinical programs on medical cost trend and quality of care. These rapid-cycle analyses should generate early and ongoing indication of whether Cohere is on the right track about meeting the targets we commit to our clients, and identify opportunities for course correction when meeting the targets is at risk. 

At a growing organization, this is a position that offers the ability to make a substantive mark on the company and its partners with exponential growth opportunity.

What you will do:

• 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. 
• Leveraging data from various sources, e.g., medical claims and data submitted by providers via the prior authorization process, working with Directors of Clinical Programs to analyze and simulate 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.  
• Work with peer actuary analysts to maintain, update and QC models to monitor and track outcome and trend.
• Work with Directors of Clinical Programs to design and conduct the impact evaluation analysis, including appropriately identifying intervention and comparison cohorts, baseline/benchmarks, unit of measurement (e.g., by procedure or diagnosis or diagnosis groups/care paths) and analytic approaches (e.g., pre- and post-, quasi-experimental design, difference in differences). The design should include sensitivity analyses and alternative definitions of key terms (e.g., comparison cohort and baseline periods) to account for confounding factors for true Cohere impact.    
• Collaborate with the analytics team and leverage Cohere data models and data infrastructures to create appropriate analytic files to support impact simulation and impact evaluation
• 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).    
• Specific routine deliverables include but not limited to: 
• Daily, weekly, and monthly reporting cadence ensures prior authorization requests match expected utilization 
• Identifying and investigating abnormal leading indicators for trend, intervening and deploying programs to curtail
• Reconciling and comparing impact of interventions and auth data with actual results showing up in claims

Your background & requirements:

• 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
• 2-3 years of professional experience in an actuarial analytics role within healthcare (payer, provider, consulting), with demonstrated analytical skills with build new predictive models and analytic solutions using tools such as GLM, logistic regression and decision trees
• Advanced knowledge of observational data analyses with large data including medical claims, pharmacy, and eligibility data
• Minimum 2 years of experience using Base SAS, SAS/Macros, and SQL or R, Python or equivalent statistical and analytical softwares
• Bachelor’s Degree in Math, Statistics, Biostatistics, Actuarial Science, or Economics required. Advanced degree preferred
• Successful completion of at least 2 or more SOA Actuarial exams, ASA preferred.

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

We can’t wait to learn more about you and meet you at Cohere Health!

Equal Opportunity Statement 

Cohere Health is an Equal Opportunity Employer. We are committed to fostering an environment of mutual respect where equal employment opportunities are available to all.  To us, it’s personal.

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