Key Facts

Remote From:

Full time

Senior (5-10 years)

English

Hard Skills

Actuarial Science Healthcare Analytics Medical Insurance Claims Utilization Management Customer Value Model Machine Readable Files Referral Marketing

Other Skills

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Collaboration
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Accountability
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Trustworthiness

Roles & Responsibilities

5–10+ years health economics, actuarial analysis, healthcare analytics, or total cost of care modeling.
Experience working with healthcare claims data and cost and utilization modeling.
Experience building value-based models that are deployed in production and used for decision-making.
Experience in value-based care and actuarial modeling.

Requirements:

Design and implement frameworks that evaluate provider performance across total cost of care, clinical quality, and downstream utilization.
Quantify variation across providers to identify actionable savings opportunities.
Develop methodologies to evaluate the downstream impact of provider selection on overall healthcare spend and member outcomes.
Partner closely with Product, Solution Engineering, Actuarial, and Data teams to inform solution design.

Job description

Description

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

We are seeking a Total Cost of Care Strategy Lead to drive savings by optimizing the relationship between quality and total cost of care. This role will develop and apply models that evaluate cost drivers including site of service, unit price, and utilization. You will serve as a subject matter expert on healthcare cost dynamics, with the ability to clearly articulate tradeoffs across different approaches to cost measurement, provider selection, and savings strategies to a range of stakeholders.

This role sits at the intersection of healthcare economics and benefit design, and will directly influence how Embold drives measurable reductions in total cost of care.

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

What you’ll do (Essential Responsibilities)

Total Cost of Care Model

Design and implement frameworks that evaluate provider performance across total cost of care, clinical quality, and downstream utilization.
Quantify variation across providers to identify actionable savings opportunities driven by differences in:
- Appropriateness
- Effectiveness
- Site of service
- Unit price
- Utilization patters
- Referral behavior
Develop methodologies to evaluate the downstream impact of provider selection on overall healthcare spend and member outcomes.
Translate complex performance and cost dynamics into clear, defensible scoring outputs that are both analytically rigorous and practically actionable.

Benefit Design & Financial Modeling

Apply the total cost of care provider scoring framework to develop benefit strategies (e.g., cost-sharing structures, deductible shifts).
Evaluate financial impact of plan changes at population level and ensure that incentive structures are economically sustainable and aligned to expected savings.

Market Insights & Innovation

Look at what our competitors are doing and identify gaps and opportunity areas (forward looking).
Innovating to anticipate and meet needs of prospective clients/the market.

Collaboration

Partner closely with Product, Solution Engineering, Actuarial, and Data teams to inform solution design.
Collaborate with market-facing teams on GTM-initiatives to refine design to meet the needs of existing clients and to evaluate opportunities for prospective clients.
All other duties as assigned.

What you’ll bring (Qualifications)

5–10+ years health economics, actuarial analysis, healthcare analytics, or total cost of care modeling.
Experience working with: Healthcare claims data and cost and utilization modeling.
Experience building value-based models that are: Deployed in production and used for decision-making.
Experience in: Value-based care and actuarial modeling.
A high degree of personal accountability and trustworthiness and a commitment to working within Quantum Health’s policies, values and ethics, and to protecting the sensitive data entrusted to us.

Preferred Qualifications

Experience in: Provider performance measurement and episode-based cost modeling
Familiarity with: Machine Readable Files (MRF) and provider attribution and referral patterns
Background in: Health economics or actuarial concepts; possibly a credentialed actuary

#LI-AK1 #LI-Remote

What’s in it for you

Compensation: Competitive base and incentive compensation
Coverage: Health, vision and dental featuring our best-in-class healthcare navigation services, along with life insurance, legal and identity protection, adoption assistance, EAP, Teladoc services and more.
Retirement: 401(k) plan with up to 4% employer match and full vesting on day one.
Balance: Paid Time Off (PTO), 7 paid holidays, parental leave, volunteer days, paid sabbaticals, and more.
Development: Tuition reimbursement up to $5,250 annually, certification/continuing education reimbursement, discounted higher education partnerships, paid trainings and leadership development.
Culture: Recognition as a Best Place to Work for 15+ years, dedication to diversity, philanthropy and sustainability, and people-first values that drive every decision.
Environment: A modern workplace with a casual dress code, open floor plans, full-service dining, free snacks and drinks, complimentary 24/7 fitness center with group classes, outdoor walking paths, game room, notary and dry-cleaning services and more!

What you should know

Internal Associates: Already a Healthcare Warrior? Apply internally through Jobvite.
Process: Application > Phone Screen > Online Assessment(s) > Interview(s) > Offer > Background Check.
Diversity, Equity and Inclusion: Quantum Health welcomes everyone. We value our diverse team and suppliers, we’re committed to empowering our ERGs, and we’re proud to be an equal opportunity employer .
Tobacco-Free Campus: To further enable the health and wellbeing of our associates and community, Quantum Health maintains a tobacco-free environment. The use of all types of tobacco products is prohibited in all company facilities and on all company grounds.
Compensation Ranges: Compensation details published by job boards are estimates and not verified by Quantum Health. Details surrounding compensation will be disclosed throughout the interview process. Compensation offered is based on the candidate’s unique combination of experience and qualifications related to the position.
Sponsorship: Applicants must be legally authorized to work in the United States on a permanent and ongoing future basis without requiring sponsorship.
Agencies: Quantum Health does not accept unsolicited resumes or outreach from third-parties. Absent a signed MSA and request/approval from Talent Acquisition to submit candidates for a specific requisition, we will not approve payment to any third party.

Reasonable Accommodation: Should you require reasonable accommodation(s) to participate in the application/interview/selection process, or in order to complete the essential duties of the position upon acceptance of a job offer, click here to submit a recruitment accommodation request.

Recruiting Scams: Unfortunately, scams targeting job seekers are common. To protect our candidates, we want to remind you that authorized representatives of Quantum Health will only contact you from an email address ending in @quantum-health.com. Quantum Health will never ask for personally identifiable information such as Date of Birth (DOB), Social Security Number (SSN), banking/direct/tax details, etc. via email or any other non-secure system, nor will we instruct you to make any purchases related to your employment. If you believe you’ve encountered a recruiting scam, report it to the Federal Trade Commission and your state’s Attorney General.