Health Plan Performance Leader - Data & Analytics

Abacus Insights; United States; À distance; USD 140 000 - 190 000; Plein temps

Avantages offerts par ce poste

Unlimited PTO

Work from anywhere

Comprehensive health coverage

Equity for every employee

Growth‑focused environment

Home office setup allowance

Monthly cell phone allowance

Résumé du poste

Abacus Insights is seeking a Senior Consultant, Health Plan Performance to serve as a payer-operations expert as we expand services for health plans. You will turn dense claims, quality, and provider data into live dashboards and AI-enabled workflows within client engagements.

You’ll guide health-plan clients on quality measures (HEDIS/STAR), provider performance, and network strategy, while collaborating with Engagement Managers, AI Engineers, and QA to roll out solutions on time.

Qualifications

• 7+ years in healthcare payer operations (or health plan performance) including provider-facing experience.
• Deep experience analyzing medical, pharmacy, financial, and provider performance data to identify trends and cost drivers.
• Proficiency in Power BI, SQL, and Tableau with a track record of building reporting tools.
• Working knowledge of quality measurement frameworks (HEDIS, STAR) and NCQA/regulatory requirements.

Responsabilités

• Serve as the Payer Business Domain SME on client engagements for payer operations.
• Advise on quality improvement and provider performance management; identify gaps and improvement plans.
• Support contracting and network strategy with data-driven recommendations.
• Analyze data to surface actionable insights and trends across client businesses.
• Build and maintain BI dashboards and AI-enabled analytics for payer workflows.
• Translate domain requirements into technical specs with Product and Engineering teams.

Connaissances

Payer operations

Provider performance management

Quality measurement (HEDIS/STAR)

Regulatory compliance

Contracting/Network strategy

Data analysis & storytelling

Cross-functional leadership

Outils

Power BI

SQL

Tableau

Description du poste

Abacus Insights is seeking a Senior Consultant, Health Plan Performance to serve as a payer-operations expert as we expand services for health plans. You will turn dense claims, quality, and provider data into live dashboards and AI-enabled workflows within client engagements.

You’ll guide health-plan clients on quality measures (HEDIS/STAR), provider performance, and network strategy, while collaborating with Engagement Managers, AI Engineers, and QA to roll out solutions on time.