Senior Consultant, Payment Integrity at Abacusinsights · LumiJobs

Responsibilities

Payment Integrity is one of the highest-stakes problems in healthcare, and you’ll be Abacus’ internal authority on it: the trusted advisor and go-to Subject Matter Expert who helps us solve it right. The Senior Consultant, Payment Integrity is an individual-contributor role for a seasoned management consultant with deep payment integrity expertise, bringing the structured problem-solving, executive presence, and client-delivery discipline of a top-tier consulting firm. You can investigate a market trend, structure a policy recommendation, and walk an executive team through why it matters, all in the same week. As we launch new and expanded service offerings, you’ll be embedded directly in client engagements, building the solution alongside our delivery team and advising our payer clients directly.
Note: This role requires travel to and from client sites, estimated at around 25%.
Own workstreams on client engagements from scoping and hypothesis development through analysis, recommendation, and implementation
Lead client discovery sessions, workshops, steering committee updates, and executive readouts, diagnosing issues, presenting data-backed recommendations, and securing buy-in from executives and payer sponsors
Serve as Abacus’ internal subject matter expert and trusted advisor for sponsors and risk panels, the go-to authority on payment integrity strategy, claims accuracy, and policy, bridging clinical, operational, and data domains
Investigate market, industry, and regulatory trends in payment integrity, and analyze compliance with federal, state, and ERISA regulations to keep policy aligned
Research contracts and design tailored payment integrity strategies, policies, and roadmaps aligned with sponsor goals and industry best practices
Create and maintain payment integrity policy for external communication, and lead cross-functional teams through implementation
Manage client relationships and expectations day to day, including scope, timelines, risks, and value realization, in partnership with the Engagement Manager
Bring client and market insights back to Product, partnering with Product, Engineering, and Data/Analytics teams to keep payment integrity outputs accurate and technically sound, including applying interoperability standards to improve audit and record-retrieval workflows
Configure and validate Abacus’ Payment Integrity accelerators, including prepay/postpay claim-edit review, prior-authorization-to-claim matching, and provider billing-anomaly detection, against each client’s specific policies and data, working inside their own Snowflake or Databricks environment
Contribute to Abacus’ consulting methodologies, reusable frameworks, accelerators, and thought leadership as our advisory practice scales

Senior Consultant, Payment Integrity

Responsibilities

Benefits

Company

Abacusinsights

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