Senior Health Plan Performance Consultant — Remote & Equity

Abacus Insights; United States; On-site; USD 130,000 - 190,000; Full time

Benefits offered by this job

Unlimited PTO

Remote-friendly

Health coverage

Equity

Growth opportunities

Home office stipend

Cell phone allowance

Job summary

Abacus Insights seeks a Senior Consultant, Health Plan Performance to lead payer-operations engagements. You will advise on quality measures, provider performance, network strategy and regulatory compliance, while building dashboards and AI-enabled workflows inside client environments.

Travel to client sites (~25%) is required. The role combines diagnostics, advisory work, and hands-on implementation with our Center of Excellence to scale offerings.

Qualifications

• Consulting background with client delivery in healthcare payer practice.
• 7+ years in healthcare payer operations (consulting or industry).
• Hypothesis-driven problem solving and executive storytelling.
• Deep experience analyzing medical, pharmacy, financial, and provider data.
• Proficiency in Power BI, SQL, and Tableau.
• Knowledge of HEDIS/STAR and NCQA compliance.
• Bachelor's degree; MBA or equivalent is a plus.

Responsibilities

• Serve as payer domain SME on client engagements.
• Structure ambiguous problems and deliver data-backed recommendations.
• Advise on quality measures and provider performance.
• Guide contracting and network strategy and regulatory compliance.
• Analyze data to surface insights and trends across books of business.
• Build BI dashboards and AI-enabled analytics for visibility.
• Manage client relationships and scope with the Engagement Manager.
• Collaborate with Product/Engineering to translate requirements.

Skills

Power BI

SQL

Tableau

Executive communication

Payer domain knowledge

Problem solving

Stakeholder management

Education

MBA or advanced degree (MBA, MHA, MPH)

Tools

Snowflake

Databricks

Job description

Abacus Insights seeks a Senior Consultant, Health Plan Performance to lead payer-operations engagements. You will advise on quality measures, provider performance, network strategy and regulatory compliance, while building dashboards and AI-enabled workflows inside client environments.

Travel to client sites (~25%) is required. The role combines diagnostics, advisory work, and hands-on implementation with our Center of Excellence to scale offerings.