Product Solutions Lead (Health Plan Segment)

Who we are

Founded in 1999, Quantum Health is a privately-owned, independent healthcare navigation organization. As the company that invented healthcare navigation, Quantum Health continues to set the standard and, in 2025, acquired the leading healthcare technology company, Embold Health. This further strengthens the AI and provider search capabilities, guiding members to the right care. Together, the teams lead the industry in healthcare navigation, simplifying care journeys, improving outcomes, and controlling rising costs for organizations of all sizes. This role supports the Embold Health division.

We’re committed to building diverse and inclusive teams across our organization, so if you’re excited about this position, we encourage you to apply – even if your experience doesn’t match every requirement.

About the role

The Product Solutions Lead (Health Plan Segment) will be a "Value Architect" and will be the strategic engine behind our Health Plan growth. You will be the primary translator for our most sophisticated buyers: Commercial leaders looking for a competitive edge, Product owners managing complex lifecycles, and Finance teams focused on the bottom line. You aren’t just identifying market needs; you are building the economic and operational case for why our solution belongs in a Payer’s core portfolio. You are the bridge between a Payer’s P&L challenges and our technical capabilities.

Location: This position may work remotely anywhere in the United States of America.

What you’ll do (Essential Responsibilities)

• Commercial & Market Synthesis: Act as the "Field Architect" alongside our Health Plan sales teams. You will participate in meetings across the sales process, peeling back the layers of a Payer’s objection to identify if the root cause is Financial (actuarial risk), Commercial (market-share loss), or Operational (implementation friction).
• Market-to-Product Synthesis: Act as the "voice of the health plan" within the internal product organization. You will take market needs, objections, and trends and synthesize them into structured recommendations for the collective roadmap.
• Financial & Actuarial Advocacy: Partner with Payer Finance and Actuarial teams to build and validate the "value story." You will build the business cases that prove how our product impacts cost of care, reduces administrative spend, or improves ROI on medical benefit programs. 
• Product Lifecycle Collaboration: Work as a key stakeholder alongside our Engineering and Payer Product teams to ensure our roadmap aligns with the "Payer Calendar" (e.g., filing cycles, bid cycles, and open enrollment readiness).
• Solution Engineering (The "Technical Closer"): Serve as the subject matter expert in deep-dive sessions with Payer leadership. You must be able to explain how our solution integrates with their claims engine and "Digital Front Door" while defending the product’s financial impact.
• Cross-Functional Liaison: Serve as the "connective tissue" between Sales, Actuarial/Legal, and Engineering to ensure that what we promise in a Payer contract is operationally sound and financially viable.
• The Collaboration Model: Engaging the Payer C-Suite
• To be successful, this individual must move fluently between three distinct internal and external "buyer" languages:
• With Commercial/Sales: You provide the "Right to Win." You help them understand how our product features translate into a competitive advantage during the January 1 renewal cycle.
• With Finance/Actuarial: You provide the "Proof." You speak the language of PMPM (Per Member Per Month) costs, risk adjustment, and claims offsets to ensure the deal clears their financial hurdles.
• With Product/Engineering: You provide the "Context." You ensure our builders understand that a "small" change in a Payer's claims feed can have massive downstream impacts on their regulatory filings.
• All other duties as assigned.

What you’ll bring (Qualifications)

• Experience: 8–12+ Years in Health Plan Operations or Strategy: Experience specifically within Commercial
• Markets, Product Development, or Actuarial/Finance divisions of a regional or national Payer.
• The "Payer-Side" Track Record: Proven history of managing or influencing a health plan's P&L. You should have experience with how a plan is priced, filed with regulators, and sold to groups.
• Cross-Functional Solutioning: Demonstrated experience sitting between "The Field" (Sales/Brokers) and "The Build" (IT/Operations) to launch a new insurance product or a high-stakes clinical program.
• B2B Enterprise Value Modeling: Experience building formal ROI models or "Value Stories" that have successfully convinced a Finance/Actuarial team to approve a new vendor or internal initiative.
• Payer Financial Mechanics: Deep fluency in MLR (Medical Loss Ratio) drivers, PMPM (Per Member Per Month) cost structures, and the "Administrative Credit" logic used by payers to justify technology spend.
• Regulatory & Filing Knowledge: High-level understanding of the Payer Product Lifecycle, including state filing requirements (SERFF), CMS compliance, and the 12–18 month lead times required for benefit design changes.
• Technical Interoperability: While not a coder, you must understand how data moves in a Payer environment—specifically Claims Data (EDI 837/835), Eligibility feeds (834), and the basics of FHIR/HL7 integration.
• Segment Knowledge: Ability to differentiate product needs across Commercial Fully-Insured, ASO (Self-Funded), and Medicare Advantage segments.
• Advanced Diagnostic Listening: The ability to conduct "Discovery" interviews with Payer stakeholders and distinguish between a Technical hurdle (IT), a Financial hurdle (Actuarial), and a Political hurdle (Executive).
• Synthesis & Narrative Building: The skill to take 50 pages of actuarial data and "Market Noise" and distill it into a 5-slide "Value Story" that a Payer VP can use to sell the solution internally.
• Collaborative Diplomacy: A "low-ego, high-influence" approach. You must be able to advocate for market needs to the Engineering team without "ordering" features, instead using data and business cases to earn priority.

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