Senior Consultant, Health Plan Performance

Abacus Insights

. Serve as the Payer Business Domain SME and consulting lead on client engagement teams .

Posted 11/3/2026full-timeRemote • Massachusetts • United StatesSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare payer operations, including HEDIS and STAR ratings, while leveraging advanced analytical skills to drive data-backed recommendations and improve provider performance. Proven ability to manage client relationships and lead cross-functional teams in ambiguous environments.

Highest-signal resume keywords

Healthcare Payer OperationsHEDIS and STAR RatingsPower BISQLProvider Performance Management

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Data AnalysisHypothesis-Driven Problem SolvingStructured AnalysisExecutive-Ready StorytellingWorkstream Leadership

Soft Skills

CommunicationInfluencing SkillsRelationship ManagementIndependent WorkDriving Results

Tools & Technologies

Power BISQLTableauAI-Enabled Reporting Tools

Certifications & Qualifications

Bachelor's DegreeMBAMHAMPH

Industry Keywords

Managed CareProvider PerformancePayment ModelsRegulatory ComplianceCost and Quality Metrics

Tech Stack

Tools & technologies

SQLTableau

About the role

Key responsibilities & impact

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

What you’ll need

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

Comp & perks

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