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

When an insurer underpays a healthcare provider for out-of-network care, the provider can dispute it through Independent Dispute Resolution (IDR), a federal arbitration process. Pivotal runs that process for our clients. Case Strategy decides how we fight each dispute: whether to settle early in open negotiation, what offer to make, which arbiter (IDRE) to pick, and what we argue in our position statement. Those decisions determine how much our clients recover.

It’s the largest product area at Pivotal, and it sits where user-facing product, Ops process design and AI meet. The foundation is in place. Now we need to build the feedback loops that make it better over time: turning what Ops does by hand into product (and improving those processes along the way), using LLM judges and evals to improve our position statements, and building ML models and running experiments to find the best offer and IDRE selection strategy. All of it ladders up to one number: how much we recover per claim.

Models only work if the operations around them do. Today, our Ops team fills the gaps in our product. You’ll start by learning how Ops works, then turn what you find into product and own initiatives of your own. You’ll report to our Product Lead.

This is a hands-on role at a startup with no set playbook. You’ll need to take initiative, dig into the data, ask a lot of questions, and build process and product together.

What You’ll Do

Bring structure to messy problems: A lot can go wrong across the IDR process. When something breaks, dig in, size it with numbers, find the root cause, and lay out clear options so the team can act.

Close the gaps between Ops and product: Learn how Ops works day to day, find where manual work is filling holes in the product, and turn it into product.

Make our decisions smarter: Use models, experiments and LLM evals to improve the offers we make, the IDREs we select and the position statements we submit.

Shape the roadmap: Use what you learn from Ops, the data and our experiments to help decide what we build next and why.

Own initiatives from discovery to launch: Define the problem, write clear requirements, and decide what to build first. After launch, measure whether it worked and keep iterating.

Partner closely with Engineering: Work through technical tradeoffs, break big problems into practical releases, and keep initiatives moving with consistent follow-through.

Who You Are

3 to 5 years of experience, including banking or management consulting and at least a year at a startup in strategy, ops or product

Strong quantitative skills. You build clear, concise, auditable spreadsheets and have a strong understanding of math and statistics.

Proficient in SQL. You can pull and check your own numbers.

Technical enough to work closely with engineers. You follow the tradeoffs and push for a decision.

Detail oriented. You notice when a number looks off, and you bring structure and clarity to messy problems.

Proactive. You spot problems early, ask a lot of questions, and act without being told.