Abacus Insights is a mission-driven technology company focused on transforming the healthcare data industry, ultimately creating a more personalized patient experience, improving health outcomes, and lowering the overall cost of healthcare. Abacus Insights provides a flexible, efficient, and secure platform that organizes and exchanges healthcare data from various sources and formats, allowing our customers to uncover differentiated insights. In addition, our employees know that they play an active role in keeping our customers' data safe and are responsible for ensuring that our comprehensive policies and practices are met.
With our deep expertise in cloud-enabled technologies and knowledge of the healthcare industry, we have built an innovative data integration and management platform that allows healthcare payors access to data that has been historically siloed and inaccessible. Through our platform, these healthcare organizations can ingest and manage all the data they need to transform their business by supporting their analytical, operational, and financial needs.
Since our founding in 2017, Abacus has built a highly successful SaaS business, raising more than $81 Million from leading VC firms with deep expertise in the healthcare and technology industries. We are solving problems of massive scale and complexity in a sector that is not only ready for disruption. We're growing quickly and would love for you to be a part of it!
About the Role:
Abacus Insights seeks an experienced professional with operational and business analysis experience in Risk, Actuarial, and Finance operations data to join our client solutions team. The successful candidate will lead the requirements gathering, analysis, and definition for solutions to support payor clients in the following areas:
- Risk profiles of the client's member population and associated performance of at-risk contracts
- CMS (Centers for Medicare & Medicaid Services) data and how it is used within a payor's financial operations
- Identifying and managing risk through the underwriting process
- Actuarial certification of claims
- Financial performance through cost management and utilization management while still delivering high-quality care
- Understanding Medical Loss Ratio (MLR) and payor initiatives supporting MLR improvements
- Operational processes supporting the areas mentioned above
This role requires an analytical thinker with experience in healthcare operations and understanding of the risk, actuarial, and finance data domains. The Client Solutions Manager - Finance & Risk must have a proven track record in leading the development of business requirements in a client-based setting. Qualities to succeed in this role include understanding the risk, actuarial, and finance data domains, strong cross-functional collaboration skills, and exceptional client engagement acumen.
The ideal candidate will be organized, self-motivated, and able to complete complex tasks with little supervision. The Client Solutions Manager will be encouraged to remain current on market trends by participating in educational opportunities, reading professional publications, maintaining personal networks, and participating in professional organizations. The Analyst will be required to work with internal and external departments and be able to position products, solutions, and services to be highly competitive to address market and client needs.
Within this data space, you will:
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Client Solutions Requirements Management: Develop business requirements using use cases that capture the client's needs. Work with the customer's designated subject matter expert to understand and gather business requirements into a Business Requirements Document (BRD). This may include elaborating on requirements with the customer, capturing acceptance criteria, and identifying non-functional requirements. The scope of requirements can vary across a broad range of client deliverables, including, but not limited to, reports, dashboards, data extracts, or views into the data used by the client for operations or analytics.
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Operational Expertise: Use your experience and knowledge in this data domain and other healthcare data to triage business requests and requirements.
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Requirements Validation: Perform tests against the delivered solution and confirm all acceptance criteria are met before handing over the solution to the client - this is a validation step performed by the author of the business requirements with assistance from other team members to simulate the actual client user acceptance testing (UAT) as a precursor to the client's actual UAT. This activity complements core testing performed by the Abacus QA team.
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User Acceptance Testing: Liaise with the client and partner with team members to coordinate and progress the client's UAT.
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Customer Relationship Management: Partner with Account Management, Program Management, Sales, and Product Management to develop strong customer relationships, resulting in reference customers.
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Collaboration and Coordination: Work closely with cross-functional teams, including business experts, technical business analysts, project managers, account executives, and data engineers, to implement client projects successfully. Collaborate with Product Management to identify client-specific requirements that may translate into an existing standard product feature or a future feature on the product roadmap.
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Training and Support: Train internal teams on business needs and use cases for seamless customer implementation. Provide ongoing support to address questions and issues raised by the implementation team.
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Cross-Functional Communication: Serve as a bridge between the client and Abacus technical teams, effectively communicating business requirements to team members.
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Change Management: Own and manage all net new requests from clients, tracking resolution using an internal project management tool.
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Awareness of Product Capabilities: Become educated and understand the strategy of new product launches, new features, and product upgrades and how they support the client.
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Process Improvement: Conduct process analysis and process evaluation and implement process improvements that lead to better solutions and client satisfaction.
What we're looking for:
- Risk, Actuarial, and Finance expertise within a Payor or Pay-vider
- Operational experience at a Payor or Pay-vider in risk and financial data management or similar areas that utilize finance data
- Bachelor's degree in health care administration, Actuarial Sciences, Computer Science, Business, or equivalent experience
- 5+ years of operational experience in risk, actuarial, and finance operations. Strong working knowledge of US healthcare data including but not limited to Medical Claims, Pharmacy Claims, Eligibility, Plan, Enrollment, Clinical, and Provider.
- Strong understanding of healthcare industry trends, regulations, and customer needs with a preference for previous payor operational experience.
- Demonstrated success driving client-facing conversations and navigating payor organizations to identify requirements.
- Business domain expertise and associated technical proficiency to deliver solutions that meet the client's needs within the healthcare finance data domain.
- Demonstrated experience navigating complex Payor and Payvider environments as an analyst or consultant eliciting a client's business requirements and building relationships
- Strong communicator who can leverage their domain expertise effectively with the client and build working relationships with internal and external team members. Ability to communicate succinctly and clearly, verbally and written, across technical and non-technical audiences at multiple levels.
- Analytical thinker who can understand and document business processes, elicit and identify implied requirements, extract insights, and translate them into comprehensive and cohesive requirements and requirement plans
- Ability to de-escalate customer complaints
- A high level of project organization, attention to detail, and time management
- "Roll up your sleeves mentality" working side-by-side with your team.
- Demonstrated ability to thrive in a fast-paced, dynamic startup environment
Equal Opportunity Employer
As a mission-led technology company helping to drive better healthcare outcomes, Abacus Insights believes that the best innovation and value we can bring to our customers comes from diverse ideas, thoughts, experiences, and perspectives. We dedicate resources to building diverse teams and providing equal employment opportunities to all applicants. Abacus prohibits discrimination and harassment regarding race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state, or local laws.
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