Senior Consultant, Health Plan Performance

Location: United States; remote work from anywhere within the United States

Company

hirify.global provides an AI and data platform that helps health plans connect healthcare data and improve operational and clinical decision-making.

What you will do

• Serve as the payer business domain subject matter expert across claims, utilization management, benefits, quality, provider performance, and network strategy.
• Advise health plans on HEDIS, STAR ratings, provider performance, cost, quality, access, and network metrics.
• Provide guidance on provider contracting, value-based and risk-sharing models, fee-for-service, total cost of care, and regulatory compliance.
• Analyze medical, pharmacy, financial, and provider performance data to identify trends, gaps, root causes, and cost drivers.
• Build dashboards, BI reporting tools, and AI-enabled analytics that support performance management and automate payer operations workflows.
• Translate payer requirements into technical specifications and collaborate with Product, Engineering, Data/Analytics, AI Engineering, and QA teams.

Requirements

• 7+ years of experience in healthcare payer operations, managed care, or health plan performance.
• 5+ years of direct provider-facing experience improving provider performance across cost and/or quality metrics.
• Hands-on experience analyzing medical, pharmacy, financial, and provider performance data.
• Proficiency in Power BI, SQL, Tableau, or similar AI-enabled reporting tools.
• Working knowledge of HEDIS, STAR ratings, NCQA, and state and federal regulatory compliance requirements.
• Strong provider relationship management, communication, influencing, independent problem-solving, and cross-functional collaboration skills.

Nice to have

• Experience with NCQA accreditation processes or state and federal quality and compliance audits.
• Experience negotiating provider contracts, administering government health plan contracts, or working with value-based and risk-based payment models.
• Experience with Agile Product and Engineering teams and documenting technical and functional requirements.
• Exposure to AI or agent-based automation tools, Snowflake, or Databricks.

Culture & Benefits

• Remote work flexibility within the United States.
• Unlimited paid time off.
• Comprehensive health coverage with multiple plan options.
• Equity for every employee and eligibility for performance bonuses.
• Home office setup allowance and monthly cell phone allowance.
• Growth-focused environment with an emphasis on collaboration, inclusion, and thoughtful use of AI and automation.

Hiring process

• Interviews are conducted by live video with the candidate's camera on.
• Advanced candidates may complete identity, work history, and location verification.
• Recruitment uses AI-supported tools, while recruiters and hiring teams make final progression and hiring decisions.