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Senior Consultant, Health Plan Performance

3 hours, 8 minutes ago
United States
Full-time
Senior
Consultant
Operations
Agile Databricks Power BI Snowflake SQL Tableau
Apply Now
Abacus Insights

Abacus Insights

Abacus Insights simplifies healthcare data with intelligent solutions, unlocking data value and empowering health plans, consumers, and providers.

Insurance
51-250
Founded 2017
$82M raised
View All Jobs 11

Description

  • Serve as the payer business domain subject matter expert across claims, utilization, benefits, quality, provider performance, and network strategy.
  • Advise clients on HEDIS, STAR ratings, provider performance, cost, quality, access, and network metrics.
  • Provide data-driven guidance on contracting, network strategy, payment models, provider reviews, and regulatory compliance.
  • Analyze medical, pharmacy, financial, and provider performance data to identify trends, risks, cost drivers, and opportunities.
  • Build and maintain BI reports, dashboards, and AI-enabled analytics for client performance monitoring.
  • Design customized reporting strategies that streamline and automate payer operations workflows.
  • Translate payer requirements into technical specifications with Product, Engineering, and Data/Analytics teams.
  • Share client and market insights with Product to inform roadmap priorities.

Requirements

  • 7+ years of experience in healthcare payer operations, managed care, or health plan performance.
  • 5+ years of direct provider-facing experience improving provider performance across cost or quality metrics.
  • Hands-on experience analyzing medical, pharmacy, financial, and provider performance data.
  • Proficiency with Power BI, SQL, Tableau, or similar AI-enabled reporting tools.
  • Working knowledge of HEDIS, STAR ratings, and NCQA, state, and federal compliance requirements.
  • Strong provider relationship management, communication, influencing, and executive presentation skills.
  • Ability to work independently, solve complex problems, and operate effectively in ambiguous cross-functional environments.
  • Experience with payment integrity or adjacent payer analytics domains.
  • Preferred: experience with NCQA accreditation, quality or compliance audits, provider contracting, Medicaid contracts, value-based payment models, or network optimization.
  • Preferred: experience in Agile product or engineering environments and exposure to AI automation tools, Snowflake, or Databricks.

Benefits

  • Base salary plus eligibility for performance bonuses and equity grants.
  • Unlimited paid time off.
  • Work-from-anywhere flexibility.
  • Comprehensive health coverage with multiple plan options.
  • Equity for every employee.
  • Growth-focused professional development environment.
  • One-time home office setup allowance.
  • Monthly cell phone allowance.

Interested in this position?

Apply directly on the company website

Apply Now

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