Note: The job is a remote job and is open to candidates in USA. Abacus Insights is hiring a Senior Business and Data Analyst to translate health-plan business needs into testable requirements and data solutions. The role analyzes healthcare data, shapes use-case designs, presents evidence-based recommendations to clients, and coordinates with delivery teams across payer data engagements.
Responsibilities
- Write and execute SQL daily to profile source data, test assumptions, quantify data quality (completeness, validity, uniqueness, consistency, timeliness), and prototype logic before it reaches the build team
- Analyze source data to establish what is actually available and reliable: field population and distributions, key integrity, duplicates, outliers, and gaps against what the business use case needs
- Reconcile and validate outputs against source systems and client-provided benchmarks (claim counts, member months, paid amounts, enrollment spans, provider rosters), investigating variances to root cause and documenting findings
- Define and document business metrics and KPIs precisely: numerator, denominator, inclusion and exclusion logic, time basis, and grain, so every consumer of the data calculates and reads them the same way
- Perform exploratory and root-cause analysis on client questions and data anomalies, and turn findings into clear, quantified recommendations for client and internal audiences
- Summarize findings through data profiling reports, analysis readouts, and visualizations that make the story clear to non-technical stakeholders
- Lead discovery sessions for your use cases, and support broader engagement-level sessions alongside the Business Solution Manager, to understand the why and what behind each use case: the business context, pain points, expected outcomes, and success criteria, rather than just the surface-level data ask
- Translate each use case into clear, testable requirements, including success criteria and non-functional requirements, and maintain traceability from business need to requirement to design to test
- Use data analysis to sharpen and challenge requirements: confirm that what the client is asking for is supported by the data they have, and surface gaps early
- Document source-to-target mappings, transformation logic, and business rules that developers can build from, and define the test conditions and expected results QA will use to validate them
- Recommend the appropriate grain and structure of a dataset given the business context, and analyze how that grain decision ripples into the downstream reports, models, or programs that consume the data
- Identify dependencies before a design is finalized: which other workstreams, reports, or client use cases touch this same data, and how a change here could break or benefit them, escalating cross-workstream impacts to the Business Solution Manager
- Apply systems thinking: recognize when a design built for one client, state, or use case can become a reusable pattern, and raise and shape that reuse rather than discovering it in hindsight
- Drive requirements-gathering and clarification conversations with client SMEs for your use cases, since incomplete or poorly elicited requirements undermine everything built downstream
- Present analysis results, data quality findings, and recommendations to client stakeholders with clarity and confidence, and guide decisions with evidence
- Represent client intent for your use cases through delivery and serve as a day-to-day point of contact, with the Business Solution Manager owning the overall client relationship
- Translate fluently between business and technical audiences, so both sides share the same understanding
- Connect the client and the internal team on your workstreams, holding the business context, data findings, and design drivers that shape the build
- Act as the business and data analysis SME for Solution Architects, Product, QA, Account Management, and Program Management, giving them clean hand-offs with the context, business rules, and analysis they need to execute without rework or reinterpretation
- Support QA and UAT by supplying validation queries, expected results, and variance analysis, and by helping triage defects to business rule, mapping, or source data causes
- Maintain awareness of the wider engagement: understand how a decision made for one workstream affects the others, and flag those ripple effects before they surface as rework
Skills
- Bachelor's degree, or equivalent relevant experience
- 5+ years working in the US healthcare domain and 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, enough to reason about business context rather than specialize narrowly in any one area
- Strong, hands-on SQL: comfortable with joins across large, multi-table datasets, window functions, CTEs, aggregations, and date/span logic, used regularly to profile, validate, reconcile, and analyze data
- Demonstrated analytical rigor: a track record of profiling data, assessing data quality, investigating anomalies to root cause, and communicating quantified findings that drove a decision
- Experience defining metrics, mentoring junior analysts, and eliciting and authoring business requirements in complex, data-driven environments
- Confident client-facing communication; able to drive a conversation, elicit requirements clearly, and present analytical findings to technical and non-technical audiences
- Comfort operating with ambiguity and re-prioritizing frequently while managing multiple use cases within a larger engagement
- Developing systems thinking: experience designing for reuse and scale across states, clients, or use cases rather than solving each case in isolation, and the ability to trace how a requirement or data model decision affects other parts of a larger data ecosystem
- Exposure to Databricks or Snowflake is desirable
- Background that already blends business analysis with hands-on data work, such as a Business Analyst, Data Analyst, or Business Data Analyst role, with exposure to client-facing delivery
- Experience with BI and visualization tools (e.g., Tableau, Power BI, or similar) to communicate analysis
- 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 the grain and structure of a dataset shape its downstream use
- Familiarity with Python or similar for analysis and automation
- Familiarity with Medicaid data or PBM platforms
Benefits
- 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
Company Overview
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