Clinical Policy Specialist at Cohere Health

Hyderabad, Telangana, India

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Not SpecifiedCompensation

Junior (1 to 2 years)Experience Level

Full TimeJob Type

UnknownVisa

HealthcareIndustries

Requirements

2-4 years of related experience in utilization management, medical policy development, health technology assessment, or payer policy configuration
Strong written and verbal communication skills in English
High attention to detail with experience in quality assurance and validation processes
Ability to work independently and collaboratively in a remote, cross-cultural team environment
Proficiency in commonly used software tools (Microsoft Word, Excel, Google Drive, Confluence, Jira)
Familiarity with healthcare data structures and clinical coding systems such as ICD-10, HCPCS, and CPT
Ability to reliably commute or relocate to Nacharam, Hyderabad, Telangana (preferred; new office in HITEC City area in early 2026)

Responsibilities

Configure and maintain medical coverage policies within Cohere’s product platform to ensure accuracy, consistency, and compliance with US industry standards
Conduct quality assurance reviews and testing of policy configurations to validate functionality and clinical relevance
Monitor updates on medical coverage policies to adjust configurations to maintain compliance with payer and regulatory requirements
Act as a subject matter expert on medical coverage policies, providing guidance to internal teams and supporting customer queries
Address internal/external customer inquiries and feedback regarding policy configurations, ensuring alignment with payers, providers, and reviewers
Collaborate with cross-functional teams, including clinical experts, product managers, engineers, medical writers, and utilization management reviewers, to optimize policy implementation and usability

Skills

ICD-10

HCPCS

CPT

Microsoft Excel

Jira

Confluence

utilization management

medical policy

quality assurance

Cohere Health

Automates prior authorization in healthcare

About Cohere Health

Cohere Health improves the prior authorization process in healthcare, which requires providers to get approval from health plans before delivering certain services. Their platform, Cohere Unify, automates and streamlines these requests by integrating with electronic medical records and using technologies like optical character recognition and machine learning. This approach allows for faster decision-making and reduces delays in patient care. The goal is to make the prior authorization process more efficient, benefiting healthcare providers, health plans, and patients.

Boston, MassachusettsHeadquarters

2019Year Founded

$103.1MTotal Funding

LATE_VCCompany Stage

AI & Machine Learning, HealthcareIndustries

501-1,000Employees

Benefits

Health Insurance

401(k) Company Match

Performance Bonus

Remote Work Options

Risks

Increased competition from AI-driven startups like Abridge threatens market share.

Flat healthcare IT deal activity may impact future funding opportunities.

Dependency on Humana partnership poses risk if challenges arise in the relationship.

Differentiation

Cohere Health automates prior authorization, reducing delays and administrative burdens.

The Cohere Unify platform integrates with EMR and uses OCR for fax submissions.

Machine learning and AI enhance decision-making based on health plan policies.

Upsides

Humana expanded Cohere's platform use, showing trust and potential for more partnerships.

Cohere raised $50 million, indicating strong investor confidence and growth potential.

KLAS award recognition highlights effectiveness, attracting more healthcare providers.

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