Senior Consultant, Health Plan Performance

This is a fully remote position, open to applicants in Massachusetts.

📋 Description

• Act as the Subject Matter Expert (SME) for the Payer Business Domain and serve as the consulting leader on client engagement teams.

• Take ownership of workstreams from initial scoping and hypothesis formulation through analysis, recommendations, and implementation.

• Organize ambiguous client challenges, validate hypotheses, and provide data-driven recommendations to health plan executives.

• Guide clients on HEDIS, STAR ratings, provider performance management, cost, quality, access, and network metrics.

• Provide advice on contracting, network strategies, payment models, provider performance evaluations, and regulatory compliance.

• Examine medical, pharmacy, financial, and provider performance data to uncover insights, cost drivers, and trends.

• Develop and sustain Business Intelligence (BI) reporting tools, dashboards, and AI-enhanced analytics.

• Create reporting strategies that optimize and automate workflows in payer operations.

• Oversee client relationships, project scope, timelines, risks, and value realization alongside the Engagement Manager.

• Collaborate with Product, Engineering, and Data/Analytics teams to convert payer requirements into technical specifications.

• Integrate client and market insights into Product roadmap priorities.

• Contribute to consulting methodologies, reusable frameworks, accelerators, and thought leadership initiatives.

⛳️ Requirements

• Background in consulting at a prestigious global firm or a leading healthcare-focused advisory firm.

• Generally, 4+ years of consulting experience, including client-facing roles within a healthcare payer or life sciences practice.

• Over 7 years of overall experience in healthcare payer operations, managed care, or health plan performance.

• More than 5 years of direct experience with providers to enhance performance across cost and/or quality metrics.

• Strong skills in hypothesis-driven problem solving, structured analysis, executive-level storytelling, and workstream leadership.

• Extensive hands-on experience in analyzing medical, pharmacy, financial, and provider performance data.

• Proficiency in Power BI, SQL, and/or Tableau or comparable AI-enabled reporting tools.

• Familiarity with HEDIS, STAR ratings, NCQA, and state and federal regulatory compliance requirements.

• Experience in payment integrity or related payer analytics domains.

• Excellent provider relationship management, communication, and influencing capabilities.

• Capacity to work autonomously and achieve results in ambiguous, cross-functional environments.

• Bachelor’s degree is mandatory.

• An MBA, MHA, MPH, or a similar advanced degree is advantageous.

• Willingness to travel to client sites, estimated at around 25%.

🏝️ Benefits

• Unlimited paid time off.

• Work from any location.

• Comprehensive health coverage with various plan options.

• Equity offered to every employee.

• An environment focused on growth and development opportunities.

• Home office setup allowance.

• Monthly cell phone stipend.

• Eligibility for performance-related bonuses.

• Equity grants.