Business Solution Manager

Summary

Abacus Insights is transforming healthcare data for health plans by creating trusted data foundations that support better care, cost, and operational decisions. The Business Solution Manager will connect client business needs to buildable solution designs by leading requirements discovery, translating requirements into data flows and business rules, analyzing data with SQL, and coordinating across clients and internal delivery teams.

Responsibilities

• Lead discovery sessions with client subject matter experts 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 a set of clear, testable requirements, with the success criteria and non-functional requirements that define what done looks like, keeping full traceability from business need to requirement
• Document the requirements unambiguously for the client and downstream teams, then translate them into a design the developers can build from: the source-to-target data flow, transformation logic, and business rules that produce the intended output
• Determine the appropriate grain and structure of a dataset given the business context, so the design answers the real question rather than an approximation of it — and trace how that grain decision ripples into every downstream report, model, or program that consumes the data
• Map the dependencies before finalizing a design: which other workstreams, reports, or client use cases touch this same data, and how a change here could break or benefit them
• Apply systems thinking as a default habit, not an exception: recognize when a design built for one client, state, or use case can become a reusable pattern, and actively design toward that reuse rather than discovering it in hindsight
• Write and execute SQL to analyze and probe data, test assumptions, and prototype throughout requirements and design. Hands-on data work is core to this role, not occasional
• Drive requirements-gathering and clarification conversations with clients, since incomplete or poorly elicited requirements undermine everything built downstream
• Represent client intent throughout the engagement and remain an active point of contact through delivery
• Translate fluently between business and technical audiences, so both sides share the same understanding
• Be the central node connecting the client and the internal team, holding the business context and design drivers that shape the build
• Act as the client's SME for Solution Architects, Product, QA, Account Management, and Program Management, giving them clean hand-offs with the context, business rules, and logic they need to execute without rework or reinterpretation
• Hold the wider view across a multi-workstream 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
• * 3+ 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
• * 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 a conversation and elicit requirements clearly
• * Comfort operating with ambiguity and re-prioritizing frequently across a large, multi-workstream engagement
• * Demonstrated systems thinking: a track record of designing for reuse and scale across states, clients, or use cases rather than solving each case in isolation — able to trace how a single requirement or data model decision affects other parts of a larger data ecosystem, and to weigh those second-order effects when making design trade-offs
• * Background that already blends business analysis with hands-on data work, such as a 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 the grain and structure of a dataset shape its downstream use
• * Familiarity with Medicaid data or PBM platforms

Qualifications

Must Haves

• * Bachelor's degree, or equivalent relevant experience
• * 3+ 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
• * 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 a conversation and elicit requirements clearly
• * Comfort operating with ambiguity and re-prioritizing frequently across a large, multi-workstream engagement
• * Demonstrated systems thinking: a track record of designing for reuse and scale across states, clients, or use cases rather than solving each case in isolation — able to trace how a single requirement or data model decision affects other parts of a larger data ecosystem, and to weigh those second-order effects when making design trade-offs

Nice to Haves

• * Background that already blends business analysis with hands-on data work, such as a 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 the grain and structure of a dataset shape its downstream use
• * Familiarity with Medicaid data or PBM platforms

Benefits

• Base salary plus eligibility for performance bonuses and equity grants
• 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