Quantum Health

Customer Success Manager

• Work closely with clients to understand their business objectives and ensure the company’s product or service delivers measurable value aligned with their goals.
• Serve as the primary point of contact for key accounts, managing day-to-day communications and ensuring strong relationships with client stakeholders at all levels.
• Lead clients through the onboarding process and drive product/service adoption by providing training, best practices, and ongoing support tailored to their specific needs.
• Identify opportunities for account growth, including upselling additional services, cross-selling complementary products, and recommending new solutions that enhance client success and increase revenue.
• Proactively manage client renewals, minimizing churn through ongoing engagement and demonstrating continuous value.
• Regularly track and assess client health, using data and insights to identify risks and opportunities for deeper engagement and growth.
• Develop and execute client success plans that align with client goals and foster long-term partnerships, driving retention and growth within assigned accounts.
• Monitor key success metrics such as adoption rates, client satisfaction scores (NPS/CSAT), and revenue growth. Regularly report progress and outcomes to both clients and internal stakeholders.
• Act as a trusted advisor and advocate for the client, ensuring any issues or concerns are addressed swiftly and effectively, coordinating with internal teams as necessary.
• Work closely with Sales, Product, Marketing, and Support teams to ensure a seamless client experience and identify opportunities for improvement or innovation in the client journey.
• Collect and relay client feedback to internal teams, providing insights to improve product offerings, services, and overall client experience.

Senior Client Success Executive

Director

• Develop and implement strategic plans for the clinical appeals program aligned with organizational goals
• Lead a team of clinical reviewers, nurses, and support staff in managing appeals and grievances
• Serve as a subject matter expert on clinical appeals, providing guidance and training to staff and leadership
• Provide daily oversight and support to the teams
• Ensure that all appeals and letters are completed within required timeframes
• Develop and review monthly reports to ensure compliance and to identify any trends
• Work with TPA partners to develop any necessary workflows
• Oversee the end-to-end appeals process, including intake, clinical review, documentation, and resolution
• Ensure compliance with URAC, and other regulatory bodies
• Monitor performance metrics (e.g., turnaround times, overturn rates, quality scores) and implement process improvements
• Review complex cases and provide clinical expertise in appeal determinations
• Collaborate with Medical Directors and external physician advisors for secondary reviews
• Maintain high standards of documentation and clinical rationale in all appeal responses
• Liaise with payers, providers, and internal departments to resolve escalated cases
• Partner with Legal, Compliance, and Quality teams to address regulatory inquiries and audits
• Represent the appeals function in cross-functional committees and initiatives
• Provide reporting for Client Executives for their groups; maintain monthly appeals/non-certification reporting
• All other duties as assigned

Director, Appeals

Medical Director

• Act as a clinical consultant and strategic partner to key employer group clients through a consultative, service-oriented clinical relationship to maximize client satisfaction, contract renewals, and adoption of new or expanded use of Quantum’s products and services.
• Participate in developing and delivering semiannual and annual reviews for client meetings to represent Quantum’s clinical operating model and actively support alignment between the clinical operating model and the clinical and benefit strategy for the client.
• Translate complex clinical trends and data into actionable insights for benefit strategy and wellness programming.
• Translate population health data into actionable, strategic recommendations tailored to client goals.
• Interpret medical and pharmacy claims, biometrics, and engagement data to identify cost drivers, care gaps, and population health risks.
• Recommend benefits and programs, as well as other interventions based on clinical data and ROI potential.
• Deliver clear, compelling presentations and reports on clinical outcomes and trends.
• Serve as the voice of the client’s health goals, ensuring that clinical programming aligns with workforce needs.
• Educate client stakeholders and brokers on trends in population health, cost containment, and value-based care.
• Serve as the primary point of escalation for complex client inquiries or concerns.
• Ensure that all clinical recommendations adhere to evidence-based guidelines and regulatory requirements.
• Provide clinical impact narratives and documentation to support renewal conversations and upsell opportunities.
• Support Account Managers in articulating the clinical value of services provided.
• Establishes criteria and protocols for standard medical treatment inquiries and renders determinations on requests for healthcare services and/or treatment.
• Conduct daily review of individual cases and have necessary case level conversations as requested. This includes prior authorizations and denial decisions for cases that do not meet established evidence-based criteria.
• Provide clear and concise documented medical review determinations and support on requested reviews within the established time frames.
• Provide clinical and nurse consultations.
• Identify opportunities to implement best practices approaches and introduce innovations to provide improved outcomes.
• Perform utilization review and case management support on complex members.
• Offer peer-to-peer discussions regarding determinations as necessary.
• Serve as a medical liaison to physicians, hospitals and insurance carriers.
• Provides determination on appeals for cases where they did not make the initial determination.

Medical Director – Medical Management, Client Partnerships

Full-stack Engineer

• Lead the design, development, and deployment of AI-driven solutions, ensuring alignment with business objectives and scalability requirements.
• Drive the adoption of cutting-edge AI technologies, including Large Language Models (LLMs), deep learning, and reinforcement learning.
• Architect end-to-end AI pipelines, integrating data engineering, model training, evaluation, and deployment in cloud and hybrid environments.
• Provide strategic guidance on AI/ML adoption, balancing innovation with business feasibility.
• Design and implement advanced AI models tailored to complex business challenges, ensuring accuracy, efficiency, and maintainability.
• Lead research and development efforts to enhance model performance, interpretability, and deployment efficiency.
• Collaborate with data teams to establish robust data strategies, including feature engineering, augmentation, and governance.
• Evaluate and introduce new AI/ML frameworks, ensuring continuous improvement and optimization of existing models.
• Serve as a technical leader, mentoring and guiding junior and mid-level engineers in AI/ML best practices, software engineering principles, and career growth.
• Set coding standards, design guidelines, and best practices for AI development and deployment.
• Lead technical discussions, providing insights on AI trends and guiding architectural decisions.
• Collaborate with leadership to influence strategic AI investments and roadmap planning.
• Oversee the development of scalable back-end services in Python, Java, or Node.js, ensuring high availability and performance for AI applications.
• Lead the development of AI-driven front-end solutions using React, focusing on creating intuitive user experiences powered by intelligent insights.
• Champion the implementation of microservices and event-driven architectures to enhance the AI platform’s modularity and scalability.
• Ensure software development follows best practices, including design patterns, automated testing, and continuous delivery.
• Lead the design and optimization of cloud-native AI solutions using AWS, Azure, or GCP, ensuring scalability, security, and cost-effectiveness.
• Architect and implement MLOps pipelines for automated model training, validation, deployment, and monitoring.
• Evaluate and optimize infrastructure costs, implementing serverless, containerized, and distributed computing solutions as needed.
• Collaborate with DevOps teams to ensure seamless integration of AI workflows into CI/CD pipelines.
• Ensure AI solutions adhere to regulatory compliance and organizational security policies.
• Implement responsible AI practices, focusing on fairness, bias mitigation, and explainability.
• Conduct AI security risk assessments and proactively address potential vulnerabilities.
• Advocate for ethical AI development, ensuring transparency and accountability in AI-driven decisions.
• Act as a key liaison between engineering, product, and business teams to drive AI initiatives that align with organizational goals.
• Translate complex technical concepts into actionable insights for non-technical stakeholders.
• Lead AI-driven innovation projects, contributing to long-term strategic initiatives.
• Present AI solutions and strategies to leadership and key stakeholders, demonstrating business value and technical feasibility.
• Stay at the forefront of AI advancements, continuously exploring new methodologies and emerging technologies.
• Represent the company in AI conferences, webinars, and industry panels to build brand credibility.
• Foster a culture of innovation by initiating AI hackathons, workshops, and training programs within the organization.
• Drive internal initiatives to explore potential new AI product offerings and capabilities.
• Other duties as assigned

Senior AI Software Engineer

• Lead, coach, and develop Client Success leads to deliver best-in-class client service.
• Set clear expectations, provide regular feedback, and drive professional growth and retention within the team.
• Provide executive-level oversight of client engagement strategies, ensuring alignment with client objectives and Quantum Health’s value proposition.
• Monitor client performance metrics (NPS, ROI, PGs, retention) and proactively address risks.
• Standardize processes and tools to ensure consistency across all client touchpoints.
• Serve as an escalation point and trusted advisor for key client stakeholders, including HR, Finance, and Benefits leadership.
• Anticipate client needs, address concerns quickly, and ensure alignment with strategic initiatives.
• Partner with internal teams (BI, Clinical, Operations, Product) to bring forward proactive insights and solutions.
• Build and maintain relationships with clients’ consultants, brokers, and advisors to reinforce Quantum Health’s value.
• Ensure accurate, timely, and strategic communication to consultants to support client renewals and growth.
• Partner cross-functionally to enhance processes, reporting, and client communications.
• Identify and implement best practices that improve efficiency, client satisfaction, and long-term retention.
• Contribute to enterprise initiatives that strengthen Quantum Health’s competitive positioning and scalability.
• All other duties as assigned.

Director, Client Engagement

General Counsel

Location: This position may work remotely anywhere in the United States of America or may work hybrid from our Dublin, Ohio location.
The Associate General Counsel – Benefits Administration & Service Contracts serves as a trusted legal advisor on matters related to employer sponsored group health plan administration, including, but not limited to ERISA, ACA, MHPAEA, Medicare, state insurance law and HIPAA compliance, fiduciary governance, and general contract negotiation as a service provider to group health plan sponsors and downstream vendor service agreements.
This role supports the legal team providing first-level support for operational compliance issues related to utilization management programs, wellness program incentive management, claim and appeal administration support, and clinical excellence in addition to negotiating complex client and downstream vendor service contracts in partnership with cross-functional stakeholders.
Negotiate and draft client and downstream vendor contracts, as well as contracts with third-party administrators (TPAs), pharmacy benefit managers (PBMs), wellness vendors, stop-loss carriers, point solutions, and insurers.
Provide strategic counsel on the design, implementation, and administration of health and welfare benefit plans, including medical, dental, vision, EAP, wellness, and flexible spending accounts (FSAs).
Ensure compliance with all applicable laws and regulations, including ERISA, HIPAA, ACA, COBRA, and relevant state insurance laws.
Draft, review, and maintain plan documents, summary plan descriptions (SPDs), and related participant communications to ensure regulatory compliance and clarity.
Respond to and resolve benefits-related disputes, claims, and appeals, including oversight of external counsel when necessary.
Monitor and interpret legislative and regulatory developments affecting health and welfare benefits and implement timely updates to policies and practices.
Assist in internal and external audits, DOL investigations, or inquiries related to benefits or vendor contracts.
Provide education and training to internal stakeholders on fiduciary obligations, plan administration, and contract compliance.
Perform additional duties and special projects as assigned.

Senior Client Success Executive

Director, Appeals

Medical Director – Medical Management, Client Partnerships

Senior AI Software Engineer

Director, Client Engagement

Associate General Counsel, Benefits Administration and Service Contracts