Optimization Analyst

Job description

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 one of the first analysts on a growing team, with low-hanging fruit ready for quick wins from day one. - Your work pays off — literally: What you find determines whether clients collect on legitimate IDR claims. - Grow with a great team behind you: You'll partner closely with the Payor Optimization Strategist and a genuinely strong Client Success org, at a company invested in developing its analysts. - Bottom Line: If you love people, get jazzed working with data and have a passion for building out awesome processes, this is the role for you. 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: - Competitive compensation, including equity - Full health, dental, and vision coverage - Retirement savings plan through 401(k) - Flexible time off - Opportunities for company-wide connection and events 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.