Senior Manager, Actuarial- Modeling & Experience Studies

Company Overview:

Cohere Health is a fast-growing clinical intelligence company that’s improving lives at scale by promoting the best patient-specific care options, using leading edge AI combined with deep clinical expertise. In only four years our solutions have been adopted by health insurance plans covering over 15 million people, while our revenues and company size have quadrupled.  That growth combined with capital raises totaling $106M positions us extremely well for continued success. Our awards include: 2023 and 2024 BuiltIn Best Place to Work, Top 5 LinkedIn™ Startup, TripleTree iAward, multiple KLAS Research Points of Light, along with recognition on Fierce Healthcare's Fierce 15 and CB Insights' Digital Health 150 lists.

Opportunity Overview:

We are seeking a skilled and visionary Senior Manager, Actuarial to lead the development and execution of comprehensive cost savings and experience study models. This role will establish a dedicated infrastructure for evaluating the financial impact and ROI of Cohere’s programs, clearly demonstrating value to customers and supporting strategic growth initiatives.

The Actuarial Senior Manager will collaborate closely with our Operational Analytics and Clinical Teams to deeply understand how our products and services are designed and implemented, ensuring our models accurately reflect Cohere’s impact on outcomes and cost savings. This role will also work in partnership with our Data Team to ensure that our Enterprise Data Warehouse (EDW) has the right data in the correct format to meet evolving modeling needs. Additionally, this position will provide detailed requirements to the Data Engineering Team to enhance our data infrastructure, supporting model accuracy, scalability, and efficiency across Cohere’s growing product portfolio.

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 opportunities.

Last but not least: People who succeed here are empathetic teammates who are candid, kind, caring, and embody our core values and principles. We believe that diverse, inclusive teams make the most impactful work. Cohere is deeply invested in ensuring that we have a supportive, growth-oriented environment that works for everyone.

What you will do:

• 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.

Your background & 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.

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 and first attempt exam fee
• Company would reimburse the annual actuarial credential licensing fees
• Flexible PTO policy to accommodate the SOA 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.

The salary range for this position $165,000 to $185,000 annually; as part of a total benefits package which includes health insurance, 401k and bonus. In accordance with state applicable laws, Cohere is required to provide a reasonable estimate of the compensation range for this role. Individual pay decisions are ultimately based on a number of factors, including but not limited to qualifications for the role, experience level, skillset, and internal alignment.

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