Senior Consultant, Health Plan Performance

About this role

About Us

Abacus Insights is transforming how data and AI work for health plans. Our mission is simple: make healthcare data usable, so the people responsible for care and cost decisions can act faster, with confidence.

As the AI and Data Platform for Payer Intelligence, we help health plans break down data silos to create a single, trusted data foundation. That foundation powers better decisions—so plans can improve outcomes, reduce waste, and deliver better experiences for members and providers alike. Backed by $100M from top investors, we're tackling big challenges in an industry that's ready for change. Our platform enables GenAI use cases by delivering clean, connected, and reliable healthcare data to support automation, prioritization, and decision workflows—and it's why we are leading the way.

Our innovation begins with people. We are bold, curious, and collaborative—because the best ideas come from working together. We embrace the thoughtful use of AI and automation to drive innovation and efficiency, and we look for individuals who are curious and adaptable—those excited to leverage emerging technologies to enhance how we work—while keeping human insight, connection, and our clients at the center of every decision.

Ready to make an impact? Join us and let's build the future together.

About the Role

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%.

Your day to day

• 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

• Demonstrated consulting craft: hypothesis-driven problem solving, structured analysis, executive-ready storytelling, and the ability to lead workstreams and influence senior client stakeholders without formal authority

• Deep, hands-on experience analyzing medical, pharmacy, financial, and provider performance data to identify trends and cost drivers

• Proficiency in Power BI, SQL, and/or Tableau (or similar AI-enabled reporting tools), with a track record of building reporting tools that drive measurable business outcomes

• Working knowledge of quality measurement…