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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 looking for an Optimization Analyst to help with our fast growing team!
This Optimization Analyst sits within Operations on our Upstream Eligibility team, which makes sure the claims entering IDR are eligible so providers actually collect on their determinations. You'll be the team's first Optimization Analyst and the first point of intake for payor eligibility inquiries.
The problem you'll work on: fragmented eligibility data lets claims flow into IDR that are later deemed ineligible, which generates fees and default determinations. Payors flag claims as ineligible for federal IDR (In Network, Non-NSA, government plans), sometimes as a whole batch in a cease-and-desist email, and our product defaults some claims to Ineligible on its own. You'll review each flag, separate the truly ineligible claims from the product defaults that need correcting, run the corrective-action loop with Product, and explain the result to CS in language a CSM can take to a client.
Your first initiative is standing up our ineligible claims review process, triggered by company-wide eligibility emails. From there, you'll help move eligibility catches from reactive to proactive so clients stop paying for wasted filings. This is real greenfield: processes that don't exist yet, quick wins you can knock out early, and a direct hand in shaping what eligibility review looks like as it matures. The IDR world comes with a learning curve — we'll teach you that part. What we can't teach is curiosity, data instincts, and the people skills to work a problem across teams.
WHAT YOU’LL DO
WHO YOU ARE
EXTRA CREDIT EXPERIENCE
WHY YOU’LL LOVE WORKING HERE
We’re a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers. While we primarily hire around our core hubs–Los Angeles and New York–we remain open to exceptional talent outside those regions. Remote and hybrid flexibility varies by role and team, and is outlined in each job description.
If you’re excited by solving complex problems and making a real-world impact, we’d love to hear from you.
Benefits Include:
Ready to Make an Impact? We’re building something meaningful; and we want you on the team.
Bring your ideas, curiosity, and drive, and let’s transform healthcare reimbursement together.
EMPLOYMENT INFORMATION
Work Authorization
Candidates must be authorized to work in the United States without current or future employer sponsorship.
Equal Employment Opportunity
Pivotal Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, sex, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status.
Reasonable Accommodations
Pivotal Health provides reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws. If you need assistance during the application or interview process, please let us know.
Background Checks
Employment is contingent upon successful completion of applicable background checks, where permitted by law.
At-Will Employment
Employment with Pivotal Health is at-will and may be terminated by either party at any time, with or without cause or notice, in accordance with applicable law.