Senior Consultant, Payment Integrity

Abacus Insights

. Own workstreams on client engagements from scoping and hypothesis development through analysis, recommendation, and implementation .

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

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in payment integrity strategy, claims auditing, and reimbursement analysis, with a strong ability to lead client engagements and develop tailored policies and roadmaps. Proven track record in managing client relationships and delivering data-backed recommendations while navigating regulatory compliance.

Highest-signal resume keywords

Payment Integrity StrategyClaims Auditing WorkflowsRegulatory ComplianceClient Relationship ManagementExecutive Communication

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims AuditingPayment IntegrityReimbursement AnalysisData AnalysisHypothesis-Driven Problem SolvingPolicy DevelopmentContract ReviewFraud MitigationInteroperability StandardsHealthcare Regulations

Soft Skills

Executive PresencePolished CommunicationWorkstream LeadershipStructured AnalysisStorytelling

Tools & Technologies

SnowflakeDatabricks

Industry Keywords

Healthcare Payer PracticeFederal RegulationsState RegulationsERISA ComplianceProvider Risk Arrangements

Tech Stack

Tools & technologies

Snowflake

About the role

Key responsibilities & impact

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
Diagnose issues, present data-backed recommendations, and secure buy-in from executives and payer sponsors
Serve as Abacus’ internal subject matter expert and trusted advisor for payment integrity strategy, claims accuracy, and policy
Investigate market, industry, and regulatory trends in payment integrity
Analyze compliance with federal, state, and ERISA regulations
Research contracts and design tailored payment integrity strategies, policies, and roadmaps
Create and maintain payment integrity policy for external communication
Lead cross-functional teams through implementation
Manage client relationships and expectations, including scope, timelines, risks, and value realization
Bring client and market insights to Product, Engineering, and Data/Analytics teams
Apply interoperability standards to improve audit and record-retrieval workflows
Configure and validate Payment Integrity accelerators in client Snowflake or Databricks environments
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 5+ years of consulting experience, including client-facing delivery within a healthcare payer practice, ideally in payment integrity, claims, or reimbursement
10+ years of total experience in healthcare payment integrity, claims auditing, or reimbursement analysis
Experience across clinical, operational, and data domains
Hypothesis-driven problem solving, structured analysis, executive-ready storytelling, and workstream leadership
Deep hands-on knowledge of claims auditing workflows and claim types, including Inpatient/DRG validation, Outpatient modifiers, Post-Acute Care, Medical Necessity, and Specialty/High Cost Drugs
Experience developing, writing, and presenting payment integrity policy, strategy, and roadmaps
Strong grasp of reimbursement models, payer/provider operations, and regulatory considerations
Familiarity with provider risk arrangements, including delegated risk, capitation, and risk panels
Working knowledge of federal, state, and ERISA regulations
Experience identifying and mitigating fraud, waste, and abuse
Experience reviewing contracts for compliance and responding to audits and escalated appeals
Proven experience leading client relationships and engagements, including discovery sessions, workshops, and executive presentations
Comfort traveling to client sites as needed
Strong, polished communication skills and executive presence
Bachelor’s degree required

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