Senior Consultant, Health Plan Performance

The role

You will serve as a payer-operations expert and consulting lead for health plan clients. You will advise on quality measures, provider performance, and network strategy while building BI reporting tools and AI-enabled workflows.

What you will do

• Serve as the Payer Business Domain SME and consulting lead on client engagement teams
• Structure ambiguous client problems and deliver data-backed recommendations to executives
• Advise clients on quality improvement and provider performance management
• Provide advice on contracting and network strategy
• Analyze medical, pharmacy, financial, and provider performance data
• Build and maintain BI reporting tools, dashboards, and AI-enabled analytics
• Manage client relationships, scope, timelines, and risks
• Partner with Product, Engineering, and Data/Analytics teams to translate requirements
• Contribute to consulting methodologies, frameworks, and thought leadership

Required qualifications

• 4+ years of consulting experience, including client-facing delivery within a healthcare payer or life sciences practice
• 7+ years of total experience in healthcare payer operations, managed care, or health plan performance
• 5+ years of direct provider-facing experience with success improving provider performance
• Demonstrated consulting craft in problem solving, analysis, and storytelling
• Hands-on experience analyzing medical, pharmacy, financial, and provider performance data
• Proficiency in Power BI, SQL, and/or Tableau
• Working knowledge of quality measurement frameworks (HEDIS, STAR ratings) and NCQA, state, and federal regulatory compliance
• Strong provider relationship management, communication, and influencing skills
• Ability to work independently and solve complex problems
• Bachelor’s Degree

Nice to have

• MBA, MHA, MPH, or comparable advanced degree from a leading institution
• Experience supporting NCQA accreditation processes or state/federal quality and compliance audits
• Experience negotiating provider contracts or administering government health plan contracts
• Experience with value-based or risk-based payment models and network optimization
• Experience building or scaling a consulting offering
• Experience partnering with Product/Engineering teams in an Agile environment
• Exposure to AI or agent-based automation tools

Benefits

• Unlimited paid time off
• Work from anywhere
• Comprehensive health coverage
• Equity for every employee
• Growth-focused environment
• Home office setup allowance
• Monthly cell phone allowance

Before you apply

• Requires current authorization to work in the United States without the need for employer sponsorship
• Interviews are conducted by live video with camera on
• Candidates may be asked to complete identity and location verification

About the company

Abacus Insights is transforming how data and AI work for health plans. They provide an AI and Data Platform for Payer Intelligence to help health plans improve outcomes and reduce waste.