About Us

Abacus Insights is transforming how data works 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.
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 that can 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. Ready to make an impact? Join us and let's build the future together.

About the Role

Abacus Insights is seeking a Director, Payment Integrity Business Solutions – Claim Auditing to serve as a strategic leader to help build the next generation of AI-enabled claim auditing solutions for healthcare payers. This is a high-impact, client-facing role for a seasoned payment integrity (PI) leader with claim auditing and complex case review experience. You will serve as the primary subject matter expert (SME) for our claim auditing product line, working directly with payer clients - including IT and complex claim audit business teams, to shape how our solutions are designed, deployed, and refined. This role sits at the intersection of clinical expertise, payment integrity operational workflows, and technology-driven innovation.

What You’ll Do

Serve as the internal and external SME for end-to-end claims auditing workflows, spanning both pre-pay and post-pay audit processes
Partner with Product, Engineering, and AI teams to translate auditing workflows into intelligent, AI-powered solution requirements
Act as our client-facing expert, partnering closely with Sales and Delivery on client/prospect meetings, product demos, discovery sessions, and client support
Identify gaps between current product capabilities and real-world auditing needs; champion a roadmap that closes those gaps
Represent the voice of the complex case review audit team in cross-functional product discussions, ensuring clinical accuracy and operational practicality
Partner with product and growth marketing on sales enablement, growth marketing initiatives, thought leadership, and GTM execution

What You Bring to the Team

10+ years of hands-on experience at a payer or payer vendor in a product or operational role with focus on complex claims auditing
Deep, hands-on knowledge of end-to-end complex claims auditing workflows
Clinical training or active coding certification
Expertise in one or more of the following complex claim types: Inpatient (DRG validation), Outpatient (modifiers), Post-Acute Care, Medical Necessity, Specialty/High Cost Drugs
Knowledge of payer-side data systems (claims adjudication platforms, audit automation engines, care management systems)
Familiarity with audit-relevant regulatory frameworks: CMS guidelines, Medicare/Medicaid audit requirements, RAC/MAC/OIG standards
Ability to translate complex clinical and operational requirements into clear product and technical specifications for non-clinical stakeholders
Demonstrated ability to engage, consult, and build trust with payer clients at the operational and leadership levels

What We Would Love to See, but Not Required

Exposure to adjacent payment integrity disciplines including clinical claim editing, post-payment recovery, fraud/waste/abuse (FWA) detection, and Special Investigations
Exposure to Agile or lean product development environments

What you’ll get in return

Unlimited paid time off – recharge when you need it
Work from anywhere – flexibility to fit your life
Comprehensive health coverage – multiple plan options to choose from
Equity for every employee – share in our success
Growth-focused environment – your development matters here
Home office setup allowance – one-time support to get you started
Monthly cell phone allowance – stay connected with ease #LISB1 #LI-Remote

Our Commitment as an 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. Therefore, 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.

At the heart of who we are is a commitment to continuously and intentionally building an inclusive culture—one that empowers every team member across the globe to do their best work and bring their authentic selves. We carry that same commitment into our hiring process, aiming to create an interview experience where you feel comfortable and confident showcasing your strengths. If there’s anything we can do to support that—big or small—please let us know.

Director, Payment Integrity Business Solutions – Claim Auditing

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