Senior Consultant, Health Plan Performance

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

What you bring to the team

- A consulting background at a top-tier global firm, such as McKinsey, BCG, Bain, Deloitte, PwC, EY, KPMG, Accenture, Oliver Wyman, or Guidehouse, or a leading healthcare-focused advisory firm such as Chartis, Huron, Milliman, or Optum Advisory. We typically see 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 (consulting or industry), including 5+ years of direct provider-facing experience with demonstrated success improving provider performance across cost and/or quality metrics

Compensation for this role is based on experience, skills, and location, and includes base salary plus eligibility for performance bonuses and equity grants.

- Unlimited paid time off: recharge when you need it

- Work from anywhere: flexibility to fit your life

- Comprehensive health coverage: multiple plan options to choose from

- Equity for every employee: share in our success

- Growth-focused environment: your development matters here

- Home office setup allowance: one-time support to get you started

- Monthly cell phone allowance: stay connected with ease

Our Commitment as an Equal Opportunity Employer

As a mission-led technology company helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. Therefore, we dedicate resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment regarding race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.

At the heart of who we are is a commitment to continuously and intentionally building an inclusive culture—one that empowers every team member across the globe to do their best work and bring their authentic selves. We carry that same commitment into our hiring process, aiming to create an interview experience where you feel comfortable and confident showcasing your strengths. If there’s anything we can do to support that—big or small—please let us know.

AI Use in Recruitment

We use AI-powered tools throughout our recruitment process. This includes Greenhouse's Real Talent Matching Technology, which helps prioritize applications based on job-related criteria, as well as additional AI tools used to support sourcing, interview preparation, and other recruiting tasks. We do not remove the human element—our recruiters and hiring teams review all applications and make all decisions related to candidate progression and hiring, regardless of which tools are used to support that process.

Identity and Location Verification

To protect the integrity of our hiring process, all interviews are conducted by live video with your camera on. Virtual or blurred backgrounds and headsets are not permitted absent an approved accommodation, and you should be in a well-lit, private space where your face and surroundings are clearly visible. Candidates who advance may also be asked to complete identity and location verification, which may include verifying your identity, work history, and confirming that you are located where your application states. Applications containing knowingly false or materially misrepresented information, including identity, location, or credentials, may be disqualified, and any offer may be rescinded if a material misrepresentation is discovered at any point in the process.