Abacus Insights offers a data management solution that standardizes data across the healthcare ecosystem by providing a highly secure unified data infrastructure that minimizes change management and maximizes analytics enablement to help healthcare providers... Backed by BlueCross BlueShield Venture Partners.
About the role
Payment Integrity is one of the highest-stakes problems in healthcare, and you’ll be Abacus’ internal authority on it: the trusted advisor and go-to Subject Matter Expert who helps us solve it right. The Senior Consultant, Payment Integrity is an individual-contributor role for a seasoned management consultant with deep payment integrity expertise, bringing the structured problem-solving, executive presence, and client-delivery discipline of a top-tier consulting firm. Found on 1752vc Careers, the job board for startup and VC roles.
What they're looking for
- 10+ years of total experience in healthcare payment integrity, claims auditing, or reimbursement analysis (consulting or industry), with comfort working across clinical, operational, and data domains
- 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 knowledge of complex claims auditing workflows and claim types (Inpatient/DRG validation, Outpatient modifiers, Post-Acute Care, Medical Necessity, Specialty/High Cost Drugs)
- Familiarity with provider risk arrangements (delegated risk, capitation, risk panels) and how payment integrity policy applies to them
- Working knowledge of federal, state, and ERISA regulations, and experience identifying and mitigating fraud, waste, and abuse, including 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, with comfort traveling to client sites as needed
More 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...
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