Senior Actuarial Manager

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 strategic and analytical Senior Actuarial Manager to lead the development and execution of cost-saving models and clinical analytics that drive actionable insights. This role will be instrumental in building a robust actuarial infrastructure to evaluate the financial impact and ROI of Cohere’s programs while supporting key business functions, including:

• Pricing and IBNR modeling
• Medical claims utilization and unit cost trend analysis
• Claims payment integrity and gap analysis
• Financial modeling to demonstrate value to customers
• Early indicator analysis and reporting
• Actuarial propensity score study
• Cost saving and impact analysis

As a key partner to both internal and external stakeholders, this individual will play a pivotal role in supporting strategic growth initiatives, customer engagement, and operational decision-making.

We are looking for a results-driven leader with a passion for healthcare analytics, financial impact measurement, and data-driven strategy to help shape the future of Cohere’s actuarial capabilities.

The Actuarial Senior Manager will collaborate closely with our Sales, Customer Success, IT, 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:

Develop and Implement Comprehensive Cost Savings Models

• Build robust, multi-faceted actuarial models to quantify Cohere’s impact on both gross, net and incremental savings, leveraging activity-based and claims-based approaches.
• Incorporate sentinel effects, risk adjustments, unit cost trends, and utilization patterns to ensure precise and consistent valuation of Cohere’s value to customers, supporting satisfaction, retention, and business growth.

Lead Pricing, Experience Studies, and Assumption Development

• Conduct experience studies to refine key assumptions and enhance the accuracy of pricing and cost-saving projections.
• Collaborate with customer-facing cost savings teams to integrate model outputs into operational workflows, ensuring data-driven decision-making.

Drive Model Integration and Automation

• Translate actuarial methodologies into IT system requirements to streamline automation and enhance model efficiency.
• Support the development of cloud-based dashboards, ensuring accurate, scalable, and user-friendly reporting.

Advance Model Development and Research

• Continuously refine models to measure Cohere’s impact on provider behavior and patient outcomes through sentinel effect analysis.
• Align models with industry standards, adjusting for population risk, pricing trends, and utilization patterns.

Support Strategic Growth and Business Expansion

• Develop growth opportunity models to assess the financial potential of new specialty categories and expanded program offerings.
• Provide data-driven insights to support business expansion beyond utilization management.

Mentor, Maintain, and Optimize Actuarial Models

• Guide and mentor actuarial analysts in maintaining, enhancing, and reviewing financial models for accuracy and relevance.
• Ensure models are scalable and adaptable to multiple programs, care pathways, and payer segments (Medicare Advantage, Commercial, Medicaid, etc.).

Ensure Methodology Transparency and Scalability

• Maintain comprehensive documentation of methodologies, impact evaluations, and coding to ensure reproducibility and scalability.
• Align documentation to support a standardized actuarial approach across all programs and stakeholders.

This role presents a unique opportunity to drive innovation in actuarial modeling, shape the financial evaluation of Cohere’s programs, and play a pivotal role in strategic decision-making.

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 is $165,000 to $180,000 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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