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Abacus Insights is transforming how data works for health plans by making healthcare data usable so decision-makers can act faster with confidence. The company helps health plans break down data silos to create a single, trusted data foundation that powers better decisions, improved outcomes, reduced waste, and better member and provider experiences. Backed by $100M in funding, Abacus is leading the way in enabling GenAI use cases through clean, connected, and reliable healthcare data.
As a Business Solution Manager, you will be the connective tissue between a client's business needs and the design that delivers them. You'll own the definition and quality of business requirements throughout an engagement, ensuring business intent, scope, and success criteria are unambiguous, then carry that understanding through to design so developers receive clean, buildable specifications rather than open questions.
Your day-to-day responsibilities include:
**Requirements-to-Design Arc**: Lead discovery sessions with client subject matter experts to understand the why and what behind each use case—business context, pain points, expected outcomes, and success criteria. Translate use cases into clear, testable requirements with success criteria and non-functional requirements. Document requirements unambiguously for clients and downstream teams, then translate them into designs developers can build from. Determine appropriate dataset grain and structure given business context. Map dependencies before finalizing design to understand which other workstreams or use cases touch the same data. Apply systems thinking as default: recognize when a design built for one client or use case can become a reusable pattern and actively design toward reuse.
**Hands-On Data Work**: Write and execute SQL to analyze, probe, and test assumptions throughout requirements and design. Hands-on data work is core to this role, not occasional.
**Client-Facing Anchor**: Drive requirements-gathering and clarification conversations with clients. Represent client intent throughout the engagement and remain an active point of contact through delivery. Translate fluently between business and technical audiences.
**Cross-Delivery Collaboration**: Be the central node connecting clients and internal teams, holding business context and design drivers. Act as the client's SME for Solution Architects, Product, QA, Account Management, and Program Management. Hold the wider view across multi-workstream engagements and flag ripple effects before they surface as rework.
Our clients are US health plans and their partners, with engagements spanning everything needed to make their data usable—standardizing and migrating data onto new platforms, meeting regulatory and compliance mandates, or powering analytics and reporting programs that drive payer performance across Medicare, Medicaid, and Commercial lines of business.
**Requirements:**
- Bachelor's degree or equivalent relevant experience
- 3+ years working in the US healthcare domain with healthcare data (claims, provider, membership/eligibility, benefits, prior authorization, or PBM)
- Payer experience required: direct experience working with or for a US health plan (Medicare, Medicaid, or Commercial), whether in-house or through healthcare consulting
- Working command of core payer concepts such as membership/enrollment, provider, claims, and authorizations
- Able to write and execute SQL to explore, probe, and prototype against data; SQL is required; exposure to Databricks or Snowflake is desirable
- Experience eliciting and authoring business requirements in complex, data-driven environments
- Confident client-facing communication; able to drive conversations and elicit requirements clearly
- Comfort operating with ambiguity and re-prioritizing frequently across large, multi-workstream engagements
- Demonstrated systems thinking: track record of designing for reuse and scale across states, clients, or use cases; ability to trace how a single requirement or data model decision affects other parts of a larger data ecosystem and weigh second-order effects when making design trade-offs
**Desirable (not required):**
- Background blending business analysis with hands-on data work (e.g., Business Analyst or Business Data Analyst role)
- Familiarity with HEDIS and Stars quality reporting, risk adjustment, payment integrity, value-based care analytics, provider data management, or CMS interoperability (CMS-0057)
- Working knowledge of data modeling concepts, including how grain and structure of a dataset shape downstream use
- Familiarity with Medicaid data or PBM platforms
