Senior Consultant, Health Plan Performance

🔥 1 minute ago

🍂 Massachusetts – Remote

🍂 Massachusetts – Remote

⏰ Full Time

🟠 Senior

💼 Consultant

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Abacus Insights

WebsiteLinkedInAll Job Openings

51 - 200 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Abacus Insights is a leader in health plan data solutions that empowers healthcare payers by providing usable and interoperable data. The company offers a comprehensive suite of data solutions designed to address complex government mandates and improve payer readiness. Abacus Insights' platform is capable of consolidating and normalizing diverse data sources into comprehensive patient records, ensuring data accuracy, and facilitating timely data updates. Their solutions support multiple use cases, including risk adjustment, clinical data exchange, cost management, and performance reporting. With a focus on technology and healthcare, Abacus Insights helps payers manage costs and improve member experiences through enhanced data management capabilities.

📋 Description

• Serve as the Payer Business Domain SME and consulting lead on client engagement teams • Own workstreams from scoping and hypothesis development through analysis, recommendation, and implementation • Structure ambiguous client problems, test hypotheses, and deliver data-backed recommendations to health plan executives • Advise clients on HEDIS, STAR ratings, provider performance management, cost, quality, access, and network metrics • Advise on contracting, network strategy, payment models, provider performance reviews, and regulatory compliance • Analyze medical, pharmacy, financial, and provider performance data to identify insights, cost drivers, and trends • Build and maintain BI reporting tools, dashboards, and AI-enabled analytics • Design reporting strategies that streamline and automate payer operations workflows • Manage client relationships, scope, timelines, risks, and value realization with the Engagement Manager • Partner with Product, Engineering, and Data/Analytics teams to translate payer requirements into technical specifications • Feed client and market insights into Product roadmap priorities • Contribute to consulting methodologies, reusable frameworks, accelerators, and thought leadership

🎯 Requirements

• Consulting background at a top-tier global firm or leading healthcare-focused advisory firm • Typically 4+ years of consulting experience, including client-facing delivery within a healthcare payer or life sciences practice • 7+ years of total experience in healthcare payer operations, managed care, or health plan performance • 5+ years of direct provider-facing experience improving provider performance across cost and/or quality metrics • Hypothesis-driven problem solving, structured analysis, executive-ready storytelling, and workstream leadership • Deep hands-on experience analyzing medical, pharmacy, financial, and provider performance data • Proficiency in Power BI, SQL, and/or Tableau or similar AI-enabled reporting tools • Working knowledge of HEDIS, STAR ratings, and NCQA, state, and federal regulatory compliance requirements • Exposure to payment integrity or adjacent payer analytics domains • Strong provider relationship management, communication, and influencing skills • Ability to work independently and drive results in ambiguous, cross-functional situations • Bachelor’s degree required • MBA, MHA, MPH, or comparable advanced degree is a plus • Travel to and from client sites, estimated at around 25%

🏖️ Benefits

• Unlimited paid time off • Work from anywhere • Comprehensive health coverage with multiple plan options • Equity for every employee • Growth-focused environment and development opportunities • Home office setup allowance • Monthly cell phone allowance • Eligibility for performance bonuses • Equity grants

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