Clinical Policy Specialist

Opportunity Overview:

Join our Clinical Content team and play a key role in shaping evidence-based medical policy configurations that drive smarter more efficient healthcare decisions. This opportunity offers a unique blend of clinical insight technology and collaboration across product engineering and medical teams. Youll help ensure our platform delivers accurate compliant and clinically sound coverage guidance to payers and providers.

What youll do:

• Configure and maintain medical coverage policies within Coheres 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

Required Qualifications:

• 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 commute/relocate:

• Nacharam Hyderabad Telangana*: Reliably commute or planning to relocate before starting work (Preferred)
  *we will be opening a new office in the HITEC City area in early 2026

Interview Process*:

1. Connect with the Talent Acquisition Partner for a Preliminary Phone Screening
2. Meet the Hiring Manager!
3. Technical Interview
4. Cross Functional Interview
5. Team Interview

*Subject to change

About ZignaAI a Cohere Health Company:

Cohere Healths clinical intelligence platform delivers AI-powered solutions that streamline access to quality care by improving payer-provider collaboration cost containment and healthcare economics. Cohere Health works with over 660000 providers and handles over 12 million prior authorization requests annually. Its responsible AI auto-approves up to 90% of requests for millions of health plan members.

With the acquisition of ZignaAI weve further enhanced our platform by launching our Payment Integrity Suite anchored by Cohere Validate an AI-driven clinical and coding validation solution that operates in near real-time. By unifying pre-service authorization data with post-service claims validation were creating a transparent healthcare ecosystem that reduces waste improves payer-provider collaboration and patient outcomes and ensures providers are paid promptly and accurately.

Cohere Healths innovations continue to receive industry wide recognition. Weve been named to the 2025 Inc. 5000 list and in the Gartner Hype Cycle for U.S. Healthcare Payers (2022-2025) and ranked as a Top 5 LinkedIn Startup for 2023 & 2024. Backed by leading investors such as Deerfield Management Define Ventures Flare Capital Partners Longitude Capital and Polaris Partners Cohere Health drives more transparent streamlined healthcare processes helping patients receive faster more appropriate care and higher-quality outcomes.

The Coherenauts as we call ourselves 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.

We cant wait to learn more about you and meet you at ZignaAI a Cohere Health company!

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 its personal.