Claims Auditor

Opportunity Overview: We are seeking a versatile and highly skilled Lead Claims Auditor to join our dynamic Payment Integrity team. This critical role involves conducting comprehensive professional and facility coding reviews—encompassing both outpatient/professional and inpatient claims—to ensure the accuracy of code assignment, DRG/reimbursement, and to maximize overpayment identification. If you possess a CPC and/or CCS credential, expert knowledge of CPT, HCPCS, and ICD-10-CM/PCS coding guidelines, and a passion for deep analytical auditing, you will be instrumental in supporting our commitment to accurate reimbursement solutions. This opportunity requires a self-motivated individual who thrives on precision, compliance, and continuous learning in a high-growth environment What you’ll do: Conduct comprehensive coding reviews to ensure accuracy in code assignment and reimbursement. Conduct comprehensive outpatient and professional coding reviews to ensure accuracy in code assignment and reimbursement. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Conduct ambulatory surgery center, emergency room, observation and infusion coding reviews. Apply expert knowledge of coding guidelines and utilize industry-leading tools to maximize overpayment identifications. Craft clear, concise, and well-supported audit findings, backed by AHA Coding Clinic Guidelines and ICD-10-CM/PCS regulations. Utilize advanced DRG encoder tools (such as 3M, Webstrat) to drive efficiency and accuracy in audits. Meet or exceed company quality and productivity standards, including strong uphold rates for appeals. Stay ahead of industry trends, coding updates, and compliance regulations to maintain expert-level knowledge. Adhere to HIPAA and company policies and procedures to ensure data security and regulatory compliance. Maintain and apply superior knowledge of changes and updates to coding guidelines, reimbursement trends,

Opportunity Overview: We are seeking a Healthcare Analytics Analyst to join our Analytics team. In this role, you will conduct analyses that drive our strategy, inform product performance, and provide insights critical to the development of new clinical intervention strategies and product enhancements. You'll partner closely with cross-functional teams and clients to optimize auto-decisioning performance and deliver increased value. This is an opportunity to directly impact company growth and assist patients at a critical time in their healthcare journey. What you'll do: Research, build, execute and optimize auto-decisioning strategy for new client implementations Work with multiple types of healthcare data to build and maintain analytical and reporting solutions to support strategy and program decision making Identify optimization opportunities based on analyses to improve auto-decisioning performance and drive increased value for clients Perform quantitative analysis of health care cost, operational performance and clinical outcomes using claims and authorization data Track cost, utilization and industry trends to inform stakeholders of solution performance and provide insights around opportunities to optimize clinical value for patients, providers and payers Prepare information for clients, build reports, data visualization and self-service solutions for internal and external stakeholders Develop, review, and analyze detailed data sets leveraged for client reporting/analytics Collaborate with IPA team on rule refinement and metric tracking What you'll need: Must-haves 2-5 years in an analyst role, ideally at a health tech company, health plan, or healthcare consulting firm Has worked hands-on with claims data, authorization data, or utilization management data Proficient in SQL (daily use) Has built and maintained dashboards in Tableau or PowerBI for internal and external stakeholders Bachelor's degree in Health Informatics, Public Health, Data Analytics, o

Opportunity Overview: As Quality Specialist will implement quality measurements, scoring, and performance improvement data designed to improve operational efficiency while exceeding industry standards for quality performance. You will apply subject-matter expertise to guide and support the training and quality needs of Intake Operations. This includes building the success of the company through training and development. With a solid foundation in quality analysis, feedback, instructing/coaching; you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day QA tasks. Cohere culture is one of partnership and ownership. What you’ll do: Translate QA findings into clear insights and recommendations for operational leaders and cross-functional partners. Develop and deploy structured coaching sessions based on audit findings to improve accuracy, decision-making, and skill development. Create and ensure accuracy of SOPs, job aids, workflow guides, and new product readiness materials. Facilitate onboarding and ongoing upskilling sessions using adult learning principles and SME feedback. Lead QA/Training side of project implementations by operationalizing workflow changes, quality expectations, and training updates into the business. Partner with Product, Clinical, Client Services, and Operations to validate workflow changes and identify potential quality or compliance risks. Support change management by communicating process updates and aligning QA expectations across impacted teams. Serve as a subject matter expert and advisor to frontline leaders on quality trends, training needs, and operational readiness. Manage multiple concurrent priorities with independence, ownership, and accountability for deliverables, exercise discretion and independent judgment. Step into operational queues to maintain service levels and ensure continuity of operations, as needed during high-volume periods. Other duties as assig

Opportunity Overview: We are seeking a Team leader, Intake to join our Intake Operations. In this role, as Team leader of Intake, you will work closely with the leadership team at Cohere and report to the Sr Director of India Operations. You will be responsible for providing supervision for the lead intake specialist and intake specialist team to meet or exceed operational objectives and metrics. You will leverage both your creative skills and communication skills to promote a high performing intake team. The Team leader of Intake will be highly organized in order to plan daily operational activities and provide oversight of the intake team. You will use your professionalism, personality, and communication skills to inspire the team to meet or exceed all performance standards. 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. What you’ll do: Gain a deep understanding of Cohere’s product and our health plan partners Provide daily operational direction to the intake staff. This includes interviewing new hires, training, coaching, mentoring, quality auditing, implementation and oversight of quality improvement plans identified based on trends and other process improvements Coordinates and provides day-to-day oversight of the intake staff Manage workload balancing needs of the intake team Assist in addressing case escalations and provider issues HR management to include performance evaluations, 1:1’s with the lead intake specialist and intake staff, payroll Other duties as assigned ISMS roles and responsibilities Good knowledge of Information practices. Assist the manager in all the information security activities implementation and maintenance process. Ensuring the team and imparted with Competence related to Information security Responsible for implementation of security policies and procedures and report any issues

Opportunity overview The Learning & Development Specialist will work in support of the UM Service Operations Team at Cohere Health who conduct reviews and decision Prior Authorization requests for a patient’s medical insurance. You will implement training processes to improve staff performance and onboard new hire employees to the Cohere Operations teams, You will provide support to all functions within the Training & Quality department. With a solid foundation in Training, you are expected to be flexible and nimble in your role to manage short- and long-term projects as well as dealing with day-to-day tasks. What you’ll do: Facilitate training for the New Hire onboarding and continuous improvement of the Service Operations Staff Work with onshore teams to Develop and maintain Training materials Perform Quality Audit checks as required Coach team members for improvement Provide reporting on performance and key areas of Training Performance to Sr Leadership Lead and facilitate training programs for new-hire onboarding and ongoing development, ensuring Service Operations staff are fully prepared to meet performance, quality, and compliance expectations Design, develop, and continuously refine training materials, job aids, and workflow documentation to support new products, process changes, and organizational initiatives Conduct judgment-based quality audits across operational workflows, applying clinical and operational standards to evaluate accuracy, compliance, and readiness Provide targeted coaching and performance improvement guidance, using audit findings and behavioral insights to elevate competency, accuracy, and decision-making across teams Analyze training and quality data to identify trends, performance gaps, and opportunities, synthesizing insights into clear recommendations for senior leadership Build and deliver regular reporting on training outcomes, competency progression, audit results, and operational readiness, shaping leade

Opportunity Overview: We are seeking a Sr Business Intelligence Engineer to join our Intelligence team. In this role, you will drive the development and optimization of our analytical infrastructure, enabling efficient, scalable, and consistent reporting and analytics across the organization. You will play a critical role in shaping the foundation of our BI ecosystem—working at the intersection of engineering, data modeling, and stakeholder enablement. This is an ideal opportunity for an experienced BI engineer who can execute cross-functional projects, design performant data models, and contribute to the execution of a unified data strategy across platforms. You will also provide guidance and mentorship to junior team members and contribute to the evolution of Cohere’s modern data stack and governance practices. What you’ll do: Lead the execution and refinement of our business intelligence and analytics architecture, ensuring consistency, performance, and scalability across dashboards and self-service tools. Design and implement robust semantic and dimensional data models supporting operational, clinical, and strategic analytics use cases. Collaborate closely with data platform, analytics, and product teams to define shared data definitions, build source-of-truth datasets, and align transformations with stakeholder needs. Improve data pipeline efficiency and maintainability by establishing and enforcing best practices in dbt modeling, testing, and documentation. Support release management, quality testing, version control, and promotion of analytics assets across environments. Enable data providers and analysts to deliver high-impact dashboards and KPI frameworks using Tableau, with an emphasis on performance, usability, and governance. Serve as the primary Tableau Cloud SME for the organization, including user management, security, performance tuning, and environment configuration. Lead integration of Tableau dashboards into front-end web applications using the Ta