Staff Healthcare Analyst

We are looking for a Staff Healthcare Analyst at Abby Care. The role leads efforts spanning patient risk modeling and clinical outcomes measurement to the cost and value analysis behind the story we bring to health plans, payors, and government partners. The role is expected to be the subject matter expert for clinical and health economics analytics at the company.

Reporting to the Senior Manager of Data & Analytics, you will set the strategy and standards for how we measure risk, cost, and outcomes, and build the analytical models and studies that prove the value of family-led care. You will develop the methodology, evidence, and analysis that our Clinical, Finance, and executive teams rely on in conversations with payors, actuaries, and research partners. You will work hand-in-hand with our Clinical and Health Plan teams, and closely with Finance, Engineering, and Product on the cross-functional initiatives that power this work.

This is a full-time, hybrid role based in San Francisco, California.

Population health & risk

• Build patient stratification and risk models (e.g., utilization risk, hospitalization/adverse event risk, acuity tiers) that inform care prioritization and intervention design.

• Own risk adjustment methodology (e.g., HCC/RAF-style approaches) and ensure it aligns with payor and regulatory expectations.

• Analyze payor claims data (medical and pharmacy) to identify utilization patterns, cost drivers, and gaps in care, and to inform and validate risk models.

Health economics & value-based care

• Lead cost of care and ROI analyses (total cost of care, cost offset, medical loss ratio impact) that quantify the value of family-led care for health plans and government partners.

• Structure and analyze value-based care and risk-sharing arrangements; model shared savings, care management fees, and other VBC contract structures.

• Develop and validate the methodology, assumptions, and results that Finance rely on when negotiating with payors and actuaries and responding to audits.

Clinical outcomes & evidence generation

• Design clinical studies in partnership with the Clinical team to research and publish health outcome studies (e.g., readmission reduction, caregiver burden, quality of life), following rigorous study design and biostatistics practices.

• Own implementation of clinical quality and outcomes measurement, including alignment to industry-standard frameworks (e.g., HEDIS, Stars, state Medicaid quality measures) where relevant to our health plan partners.

• Build the evidence base (case studies, white papers, peer-reviewed publications, conference presentations) that establishes Abby Care as a credible, data-backed player in home-based care.

Cross-functional partnership

• Partner with Finance to bring clinical and health economics analysis into payor contract negotiations, arming the negotiation team with evidence on cost offset, outcomes, and value.

• Partner closely with Clinical, Health Plan, Engineering, and Product teams to define shared metrics, data models, and dashboards that create a single source of truth for clinical and financial performance.

• Establish measurement frameworks, in collaboration with relevant teams, for clinical interventions, care protocols, and product/operational experiments.

• 5+ years of experience in healthcare/clinical analytics, health economics and outcomes research (HEOR), actuarial analytics, biostatistics, or population health, with direct experience leading analytics for a business or clinical domain.

• Advanced SQL and strong proficiency in Python or R, including statistical and predictive/risk modeling.

• Hands-on experience analyzing payor claims data (medical and pharmacy), including familiarity with claims data structures and standard code sets (e.g., ICD-10, CPT, NDC).

• Direct experience working with health plans, payors, or actuaries: you can speak their language and hold your own in methodology discussions and contract conversations, even if you're not the one at the negotiating table.

• Demonstrated experience designing and executing health outcomes studies, including publication in peer-reviewed journals and/or presentation at industry conferences.

• Deep knowledge of risk adjustment, cost of care/ROI methodology, value-based care economics, and clinical quality measurement.

• Experience with dbt, Git, cloud data warehouses, and BI platforms.

• Excellent communication and stakeholder-management skills: you can translate complex analysis into something Finance, Clinical, and leadership can use with confidence in front of payors and actuaries.

• High standards for data quality, rigor, and documentation.

• Experience at a value-based care, population health, or risk-bearing healthcare organization (e.g., Medicaid MCO, home-based care company).

• Background in causal inference, survival analysis, or predictive modeling for clinical/financial risk.

• Familiarity with Medicaid, Medicare, or dual-eligible populations and their unique cost/quality dynamics.

• Experience with prior authorization, revenue cycle, or patient lifecycle data.

• Familiarity with the data requirements of AI or agentic clinical systems.