Senior Consultant, Health Plan Performance
About The Position
Abacus Insights is transforming how data and AI work for health plans. Our mission is simple: make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence. As the AI and Data Platform for Payer Intelligence, we help health plans break down data silos to create a single, trusted data foundation. That foundation powers better decisions—so plans can improve outcomes, reduce waste, and deliver better experiences for members and providers alike. Backed by $100M from top investors, we're tackling big challenges in an industry that's ready for change. Our platform enables GenAI use cases by delivering clean, connected, and reliable healthcare data to support automation, prioritization, and decision workflows—and it's why we are leading the way. Our innovation begins with people. We are bold, curious, and collaborative—because the best ideas come from working together. We embrace the thoughtful use of AI and automation to drive innovation and efficiency, and we look for individuals who are curious and adaptable—those excited to leverage emerging technologies to enhance how we work—while keeping human insight, connection, and our clients at the center of every decision. Ready to make an impact? Join us and let's build the future together.
Requirements
- 7+ years of experience in healthcare payer operations, managed care, or health plan performance — including 5+ years of direct provider-facing experience with demonstrated success improving provider performance across cost and/or quality metrics
- Deep, hands-on experience analyzing medical, pharmacy, financial, and provider performance data to identify trends and cost drivers
- Proficiency in Power BI, SQL, and/or Tableau (or similar AI-enabled reporting tools), with a track record of building reporting tools that drive measurable business outcomes
- Working knowledge of quality measurement frameworks (HEDIS, STAR ratings) and NCQA, state, and federal regulatory compliance requirements
- Exposure to payment integrity or other adjacent payer analytics domains
- Strong provider relationship management, communication, and influencing skills — comfortable leading structured performance conversations and driving accountability for outcomes
- Ability to work independently, solve complex problems, and drive results in ambiguous, cross-functional situations, translating technical analysis into clear recommendations for executives, providers, and clients alike
Nice To Haves
- Experience supporting NCQA accreditation processes or state/federal quality and compliance audits
- Experience negotiating provider contracts or administering government health plan contracts (e.g., state Medicaid), and/or experience with value-based or risk-based payment models and network optimization
- Experience partnering with Product/Engineering teams in an Agile environment, including documenting technical and functional requirements
- Exposure to AI or agent-based automation tools, or comfort partnering closely with engineers configuring analytics and reporting logic inside a cloud data platform (Snowflake, Databricks)
Responsibilities
- Serve as the Payer Business Domain SME on client engagement teams supporting our new and expanded service offerings — the go-to authority for health plan clients across payer operations: claims, utilization, benefits, quality, provider performance, and network strategy
- Advise clients on quality improvement (HEDIS, STAR ratings) and provider performance management — identifying gaps, root causes, and improvement plans across cost, quality, access, and network metrics
- Provide advice and counsel on contracting and network strategy — value-based, risk-sharing, fee-for-service, and total-cost-of-care models — and support provider performance reviews, JOCs, and regulatory compliance (state, federal, NCQA) with data-driven recommendations
- Analyze medical, pharmacy, financial, and provider performance data to surface actionable insights and trends across clients’ book of business
- Build and maintain BI reporting tools, dashboards, and AI-enabled analytics that give clients visibility into performance trends, risks, and opportunities, and design customized reporting strategies that streamline and automate payer operations workflows
- Partner with Product, Engineering, and Data/Analytics teams to translate payer domain requirements into technical specifications, and bring client/market insights back to Product to inform roadmap priorities
Benefits
- Unlimited paid time off
- Work from anywhere
- Comprehensive health coverage – multiple plan options to choose from
- Equity for every employee
- Growth-focused environment
- Home office setup allowance
- Monthly cell phone allowance
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Senior
Education Level
No Education Listed
