Job Opportunities API

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! Our Payor Optimization team sits between our clients, Client Success, and payors—working to ensure providers receive accurate and timely reimbursement following IDR determinations. Our rapidly growing business is hiring an analyst to triage CS escalations and close the loop on claims that need follow-through. With rapid scale comes rapid growth. This means real greenfield: low-hanging fruit you can knock out for quick wins, processes that don't exist yet, and a direct hand in shaping what payor compliance 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. We look forward to hearing from you! WHAT YOU'LL DO - Be the go-to for Client Success: When CS has a payor compliance question, you're their person, on tickets and on calls. You'll own the daily flow of the Asana Payor Compliance queue, dig into the client and payor situations CS flags, and pull claims data from Metabase to uncover the real root cause. - Lead deep-dive payor reviews: You'll investigate payors to find what's actually blocking payment, whether it's routing issues, INN processing, or eligibility gaps. Then you'll document what you learn and communicate a plan through data storytelling. - Be our voice with payors: Working from the team's analysis, you'll serve as our first point of contact on outreach campaigns. That means prepping emails, managing payor inboxes, tracking responses and keeping the Payor Outreach Tracker fresh at every milestone. - Shape the playbook: You'll build CS-facing materials, sharpen our SOPs as workflows evolve, and spot the patterns that turn into bigger wins. Around here, small, consistent wins compound, and you'll be the one stacking them. WHO YOU ARE - You've spent 1 to 3 years in healthcare operations, revenue cycle, managed care, consulting (highly preferred), or an analyst role in finance or healthcare. - Excel is home turf, pivot tables included. - People energize you. You're warm, personable, and quick to build trust, with genuine customer-service instincts in every conversation with CS and payors. - You write with clarity and confidence. Your findings and rationale become the language CS takes straight to clients. - You're the reliable one: detail-oriented and organized under volume, following every thread to the finish even with a full ticket queue and multiple reviews in motion. EXTRA CREDIT EXPERIENCE - Familiarity with the No Surprises Act, the NSA IDR process, or health insurance TPA/payor structures - SQL, data storytelling, or dashboard know-how in Metabase, Power BI, or similar - Comfort with Asana, Notion, or similar workflow tools WHY YOU'LL LOVE THE ROLE - Be here for the beginning: You'll be the firs