pivotal-health · Williamsburg, NY
Skills: SQL
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 numb…
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