Responsibilities

Abacus Insights is seeking a Senior Consultant, Health Plan Performance to serve as our payer-operations expert as we launch new and expanded service offerings for health plans, spanning medical and pharmacy claims, utilization management, benefits administration, quality improvement, provider performance, contracting, and regulatory compliance. This is an individual-contributor role for a seasoned management consultant with deep payer expertise and a builder’s follow-through: someone who brings the structured problem-solving, executive presence, and client-delivery discipline of a top-tier consulting firm, and who can turn dense claims, quality, and provider performance data into dashboards, agents, and reporting that ship live within the engagement’s window, not just a deck of recommendations. You’ll help shape how Abacus delivers for health plans from day one.
You’ll work inside the client’s own environment alongside the Engagement Manager, Data/Platform Engineers, AI Engineers, and QA, advising health plan clients on quality measures, provider performance, network strategy, and compliance standards, then helping build the dashboards, business intelligence, and AI-enabled workflows that put those recommendations into production. Your work spans diagnostics and advisory, through solution design, to hands-on configuration and rollout, while feeding what you learn back into our data engineering Center of Excellence as these new offerings grow.
Note: This role requires travel to and from client sites, estimated at around 25%.
Serve as the Payer Business Domain SME and consulting lead on client engagement teams, owning workstreams from scoping and hypothesis development through analysis, recommendation, and implementation
Structure ambiguous client problems, develop and test hypotheses, and deliver clear, data-backed recommendations to health plan executives (C-suite, VP, and director level) in the form of steering committee updates, readouts, and working sessions
Advise clients on quality improvement (HEDIS, STAR ratings) and provider performance management, identifying gaps, root causes, and improvement plans across cost, quality, access, and network metrics
Provide advice and counsel on contracting and network strategy (value-based, risk-sharing, fee-for-service, and total-cost-of-care models) and support provider performance reviews, JOCs, and regulatory compliance (state, federal, NCQA)
Analyze medical, pharmacy, financial, and provider performance data to surface actionable insights, cost drivers, and trends across clients’ books of business
Build and maintain BI reporting tools, dashboards, and AI-enabled analytics that give clients visibility into performance trends, risks, and opportunities, and design reporting strategies that streamline and automate payer operations workflows
Manage client relationships and expectations day to day, including scope, timelines, risks, and value realization, in partnership with the Engagement Manager
Partner with Product, Engineering, and Data/Analytics teams to translate payer domain requirements into technical specifications, and bring client and market insights back to Product to inform roadmap priorities
Contribute to Abacus’s consulting methodologies, reusable frameworks, accelerators, and thought leadership as our advisory practice scales

Senior Consultant, Health Plan Performance at Abacusinsights · LumiJobs

Senior Consultant, Health Plan Performance

Responsibilities

Benefits

Company

Abacusinsights

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