Senior Consultant, Health Plan Performance
Core
Payer-operations expert serving as a domain SME to launch new service offerings for health plans, translating dense claims and performance data into live dashboards, agents, and reporting.
Role type
Senior individual-contributor consultant (payer operations)
Builds
Dashboards, business intelligence, and AI-enabled workflows for health plan clients
Domain
Healthcare payer operations, managed care, and health plan performance
Deliverable
dashboards & analysis
Required skills
Payer operations expertise, claims/utilization/benefits/quality/provider performance knowledge, Power BI/SQL/Tableau, regulatory compliance (HEDIS/STAR/NCQA), provider relationship management
Preferred skills
NCQA accreditation experience, contract negotiation, value-based payment models, Agile environment experience, AI/automation tool exposure
Technologies
Power BI, SQL, Tableau, Snowflake, Databricks
Responsibilities
Advise clients on quality improvement and provider performance management; Provide counsel on contracting, network strategy, and regulatory compliance; Analyze medical, pharmacy, financial, and provider performance data; Build and maintain BI reporting tools and AI-enabled analytics; Partner with Product and Engineering to translate requirements into technical specifications
Seniority
Senior, hands-on IC
