[Hiring] Senior Consultant, Payment Integrity @Abacus Insights

Role Description

Payment Integrity is one of the highest-stakes problems in healthcare — and you’ll be Abacus’ internal authority on it: the trusted advisor and go-to Subject Matter Expert who helps us solve it right. The Senior Consultant, Payment Integrity is an individual-contributor role for a payment integrity practitioner with a consultant’s instincts.

Your day to day:

• Lead client discovery sessions, workshops, and presentations — diagnosing issues, presenting recommendations, and securing buy-in from executives and payer sponsors.
• Serve as Abacus’ internal subject matter expert and trusted advisor for sponsors and risk panels — the go-to authority on payment integrity strategy, claims accuracy, and policy, bridging clinical, operational, and data domains.
• Investigate market, industry, and regulatory trends in payment integrity, and analyze compliance with federal, state, and ERISA regulations to keep policy aligned.
• Research contracts and design tailored payment integrity strategies, policies, and roadmaps aligned with sponsor goals and industry best practices.
• Create and maintain payment integrity policy for external communication, and lead cross-functional teams through implementation.
• Bring client and market insights back to Product, partnering with Product, Engineering, and Data/Analytics teams to keep payment integrity outputs accurate and technically sound.
• Configure and validate Abacus’ Payment Integrity accelerators against each client’s specific policies and data.

Qualifications

• 10+ years of experience in healthcare payment integrity, claims auditing, or reimbursement analysis, including 5+ years in a consulting or advisory capacity.
• Prior experience in a healthcare payer or provider consulting/advisory practice.
• Deep, hands-on knowledge of complex claims auditing workflows and claim types.
• Consulting-style problem-solving: structuring ambiguous problems, running stakeholder workshops, and building a clear narrative from findings to recommendation.
• Experience developing, writing, and presenting payment integrity policy, strategy, and roadmaps for executive and sponsor audiences.
• Familiarity with provider risk arrangements and how payment integrity policy applies to them.
• Working knowledge of federal, state, and ERISA regulations, and experience identifying and mitigating fraud, waste, and abuse.
• Proven experience leading client relationships and engagements.
• A strong, polished communicator with genuine executive presence.

Requirements

• Six Sigma Black Belt, CPC, CCS, or CFE certification (not required).
• Clinical training or an active coding certification (e.g., RHIA, RHIT, CCS) (not required).
• Exposure to adjacent payment integrity disciplines (not required).
• Exposure to Agile or lean product development environments (not required).
• A genuine curiosity about healthcare tech, startups, and what makes companies grow (not required).
• Exposure to AI or agent-based automation tools (not required).

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.