Senior Consultant, Health Plan Performance

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 – 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