Senior Consultant, Health Plan Performance

About Us

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 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, 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.

About the Role

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.

Your Day to Day

• 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

What You Bring to the Team

• 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

What We'd Like to See, but Not Required

• 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)

Compensation

Compensation for this role is based on experience, skills, and location, and includes base salary plus eligibility for performance bonuses and equity grants.

What You'll Get in Return

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

Our Commitment as an Equal Opportunity Employer

As a mission-led technology company helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. Therefore, we dedicate resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment regarding race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

At the heart of who we are is a commitment to continuously and intentionally building an inclusive culture, one that empowers every team member across the globe to do their best work and bring their authentic selves. We carry that same commitment into our hiring process, aiming to create an interview experience where you feel comfortable and confident showcasing your strengths. If there's anything we can do to support that, big or small, please let us know.

AI Use in Recruitment

We use AI-powered tools throughout our recruitment process. This includes Greenhouse's Real Talent Matching Technology, which helps prioritize applications based on job-related criteria, as well as additional AI tools used to support sourcing, interview preparation, and other recruiting tasks. We do not remove the human element. Our recruiters and hiring teams review all applications and make all decisions related to candidate progression and hiring, regardless of which tools are used to support that process.

Identity and Location Verification

To protect the integrity of our hiring process, all interviews are conducted by live video with your camera on. Virtual or blurred backgrounds and headsets are not permitted absent an approved accommodation, and you should be in a well-lit, private space where your face and surroundings are clearly visible. Candidates who advance may also be asked to complete identity and location verification, which may include verifying your identity, work history, and confirming that you are located where your application states. Applications containing knowingly false or materially misrepresented information, including identity, location, or credentials, may be disqualified, and any offer may be rescinded if a material misrepresentation is discovered at any point in the process.

If you need an accommodation for any part of the interview process, please let your recruiter know in advance.

By applying, you acknowledge that we will collect and process your personal information for recruiting purposes in accordance with applicable data protection laws, including for the verification steps described above. Please review our Applicant Privacy Notice for more information, including your rights.