Director, Actuarial Services

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:

As the Director & Head Actuary, you will lead our actuarial team, focusing on developing and implementing innovative models for utilization management and prior authorization for new and existing clinical programs. Your day-to-day activities will involve collaborating closely with the Sr. Director of Analytics to align actuarial initiatives with our company’s strategic goals. You will serve as the primary actuarial liaison with health economics teams at health insurance plans, presenting actuarial analyses, findings, and recommendations to ensure alignment with forecasting and assessing medical impact, performance guarantees, and/or other client commitments. Building and maintaining strong relationships with key stakeholders will be crucial to understanding their needs, delivering tailored solutions, and identifying areas of risk.

You will oversee the development, validation, and maintenance of actuarial models, ensuring their accuracy, reliability, and relevance in collaboration with internal matrix partners. Your expertise in advanced statistical techniques will be essential in enhancing the performance and decision-making capabilities of our models. 

Your role will require you to stay informed about changes in healthcare policies, regulations, and industry trends that affect utilization management and prior authorizations, adapting our models and practices accordingly. Additionally, you will play a key role in mentoring and developing actuarial talent within the team, fostering a culture of continuous learning and improvement, and promoting knowledge sharing and collaboration across the analytics department.

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:

Leadership and Strategy:

• Lead the actuarial team in developing innovative models and strategies for utilization management and prior authorization for new and existing clinical programs.
• Collaborate closely with executive leadership to align actuarial initiatives with the company’s strategic goals.  
• Provide expert guidance on actuarial best practices and emerging trends in healthcare technology and AI. 

Client Engagement:

• Serve as the primary actuarial liaison with client health economics and actuarial teams.
• Present and coordinate analyses, findings, and recommendations to ensure client alignment with forecasts and assessments.

Model Development and Analysis:

• Oversee the development, validation, and maintenance of value and savings methodologies.
• Develop standards and processes to ensure the accuracy, reliability, and relevance of actuarial models, analyses, and reports.
• Continuously monitor and improve models to ensure they meet the evolving needs of clients, regulatory requirements, and internal stakeholders.

Team Development:

• Mentor and develop actuarial talent within the team, fostering a culture of continuous learning and improvement.
• Promote knowledge sharing and collaboration across the analytics department.

Your background & requirements:

• Bachelor’s or Master’s degree in Actuarial Science, Mathematics, Statistics, or a related field. 
• Fellow of the Society of Actuaries (FSA) or equivalent certification. 
• Minimum of 6 years of actuarial experience in healthcare, with a focus on claims trending, utilization management, underwriting, and/or benefits management analytics.
• Proven experience in a leadership role; experiencing managing teams and complex projects.
• Strong background in health economics and payer experience required
• Expertise in actuarial modeling, statistical analysis, and predictive analytics.
• Proficiency in programming languages and tools such as Python, R, SQL, and actuarial software.
• Excellent communication and presentation skills, with the ability to convey complex concepts to non-technical audiences.
• Strong analytical and problem-solving abilities, with a keen attention to detail.
• Ability to work collaboratively in a fast-paced, dynamic environment.

 

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 $175,000 to $215,000 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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Last updated on Aug 15, 2024