About Pivotal Health

Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape.

Today, many providers face persistent underpayment from health insurance companies, despite delivering high-quality care. While processes like IDR (Independent Dispute Resolution) were designed to promote fairness, they’re often administrative-heavy, time-consuming, and difficult to navigate without the right tools.

Pivotal Health combines software, data, and service into a seamlessly integrated, AI-driven platform that simplifies these complex reimbursement workflows. We help providers efficiently dispute underpaid claims, reduce administrative burden, and recover the reimbursement they’re entitled to; without adding more work to already stretched teams.

Our full-service IDR solution is just the starting point. We’re building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey.

About the Role

We're hiring a back-end leaning Senior Full-Stack Engineer, Case Strategy to help build new products at Pivotal from the ground up. This role sits on the AI focused Case Strategy, working on new product surfaces that combine software, data, workflow design, and AI to solve high-value customer problems. We're looking for someone comfortable owning product behavior end to end while being especially strong in APIs, backend systems, data flows, and the logic that makes great products actually work.

This is a high-ambiguity, high-velocity role. You won't be handed perfectly scoped tickets or asked to maintain a mature product in a narrow lane; you'll help shape what we build, how we build it, and how quickly we can turn ideas into valuable product experiences. We're also looking for someone who is AI-first in how they work: personally fluent with AI tools, able to use them to move faster, think better, and build stronger products, and help the company get dramatically better at using AI overall.

The problems here are real, messy, and close to actual customer and business pain, not speculative side projects. This team sits at the intersection of AI, product, data, and operations, which creates unusual leverage for a strong engineer. You'll have genuine room to shape direction and use both sides of your skill set: deep backend engineering and pragmatic full-stack product development.

What You'll Do

Build new product experiences from 0 to 1 across backend services, APIs, integrations, and frontend workflows

Design and implement backend systems that power product logic, orchestration, data access, and AI-enabled workflows

Contribute to frontend product development in React-based applications, especially where product quality depends on tight frontend-backend iteration

Work closely with product, design, operations, and AI/ML partners to turn ambiguous ideas into shipped product

Prototype quickly, then harden what works into maintainable product systems

Build internal and customer-facing workflows that use AI, structured data, and software automation to increase leverage

Help define product requirements through direct technical judgment, not just implementation after decisions are made

Improve product quality through instrumentation, testing, thoughtful system design, and strong engineering hygiene

Use AI actively in your own workflow for coding, debugging, investigation, product exploration, and iteration

Raise the team's velocity by bringing AI-native working habits, practical engineering judgment, and strong product instincts

Who You Are

A strong product-minded software engineer who likes building things that users feel directly

Fullstack, but your center of gravity is backend systems and product logic

Comfortable moving quickly in ambiguous environments and can make good decisions without waiting for perfect clarity

High ownership mindset and enjoy driving work from rough idea to production

Care about product quality, not just technical elegance