[Hiring] Senior Consultant, Health Plan Performance @Abacus Insights

Role Description

Abacus Insights is seeking a Senior Consultant, Health Plan Performance to serve as our payer-operations expert as we launch new and expanded service offerings for health plans, spanning medical and pharmacy claims, utilization management, benefits administration, quality improvement, provider performance, contracting, and regulatory compliance. This is an individual-contributor role for a payer operations practitioner with a builder’s follow-through — someone who can turn dense claims, quality, and provider performance data into the dashboards, agents, and reporting that ship live within the engagement’s window, not just a set of recommendations. You’ll help shape how Abacus delivers for health plans from day one.

You’ll work inside the client’s own environment alongside the Engagement Manager, Data/Platform Engineers, AI Engineers, and QA, advising health plan clients on quality measures, provider performance, network strategy, and compliance standards — then helping build the dashboards, business intelligence, and AI-enabled workflows that put those recommendations into production. Your work spans analysis and advisory, through solution design, to hands-on configuration and rollout, while feeding what you learn back into our data engineering Center of Excellence as these new offerings grow.

• Serve as the Payer Business Domain SME on client engagement teams supporting our new and expanded service offerings.
• Advise clients on quality improvement (HEDIS, STAR ratings) and provider performance management.
• Provide advice and counsel on contracting and network strategy.
• Analyze medical, pharmacy, financial, and provider performance data to surface actionable insights and trends.
• Build and maintain BI reporting tools, dashboards, and AI-enabled analytics.
• Partner with Product, Engineering, and Data/Analytics teams to translate payer domain requirements into technical specifications.

Qualifications

• 7+ years of experience in healthcare payer operations, managed care, or health plan performance.
• 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.
• Proficiency in Power BI, SQL, and/or Tableau (or similar AI-enabled reporting tools).
• Working knowledge of quality measurement frameworks (HEDIS, STAR ratings) and NCQA, state, and federal regulatory compliance requirements.
• Strong provider relationship management, communication, and influencing skills.
• Ability to work independently, solve complex problems, and drive results in ambiguous, cross-functional situations.

Requirements

• Experience supporting NCQA accreditation processes or state/federal quality and compliance audits (preferred).
• Experience negotiating provider contracts or administering government health plan contracts (e.g., state Medicaid).
• Experience partnering with Product/Engineering teams in an Agile environment.
• Exposure to AI or agent-based automation tools.

Benefits

• Unlimited paid time off – recharge when you need it.
• Work from anywhere – flexibility to fit your life.
• Comprehensive health coverage – multiple plan options to choose from.
• Equity for every employee – share in our success.
• Growth-focused environment – your development matters here.
• Home office setup allowance – one-time support to get you started.
• Monthly cell phone allowance – stay connected with ease.