Health Plan Performance Consultant - Payer Ops & BI

Abacus Insights; Northern (KY); Remote; USD 120,000 - 170,000; Full time

Benefits offered by this job

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

Job summary

Abacus Insights is a health-tech company seeking a Senior Consultant, Health Plan Performance to turn dense claims, quality, and provider data into dashboards and AI-enabled workflows for health plans. You will advise on quality measures, provider performance, and network strategy while helping design and deploy analytics in client environments.

In this role you’ll work with Engagement Managers and cross-functional teams to translate requirements into technical specs, build dashboards, and drive

Qualifications

• 7+ years of experience in healthcare payer operations, including 5+ years with providers.
• Deep experience analyzing medical, pharmacy, financial, and provider performance data.
• Proficiency in Power BI, SQL, and Tableau with a track record of building reporting tools that drive measurable business outcomes.
• Knowledge of quality measurement frameworks (HEDIS, STAR) and NCQA/regulatory requirements.
• Exposure to payment integrity or other adjacent payer analytics domains.

Responsibilities

• 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 — identifying gaps, root causes, and improvement plans.
• Provide advice and counsel on contracting and network strategy — value-based, risk-sharing, fee-for-service, and total-cost-of-care models; support provider performance reviews and regulatory compliance.
• 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 that give clients visibility into performance trends, risks, and opportunities.
• 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.

Skills

Payer operations

Provider performance

Data analysis

Power BI

SQL

Tableau

Tools

Power BI

SQL

Tableau

Job description

Abacus Insights is a health-tech company seeking a Senior Consultant, Health Plan Performance to turn dense claims, quality, and provider data into dashboards and AI-enabled workflows for health plans. You will advise on quality measures, provider performance, and network strategy while helping design and deploy analytics in client environments.

In this role you’ll work with Engagement Managers and cross-functional teams to translate requirements into technical specs, build dashboards, and drive