Senior Manager, State IDR

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 State arbitration is a growing and increasingly important part of our business, and it has reached the point where it needs a dedicated leader driving strategy, operations, and execution. We’re hiring a Senior Manager to build state arbitration into a formal, standalone function with its own strategy, workflows, and team. You’ll inherit the State Arbitration team directly, take on management scope currently sitting with our VP of Operations, and own the department end to end. You'll own the full lifecycle of state arbitration: which of the ~20 states with meaningful volume we pursue and when, how we build and formalize the filing process in each, and how we recover claims currently defaulting into the federal process that should be filed at the state level instead. You'll partner closely with Data & Analytics to spot trends before they're obvious, and with Product & Engineering to turn what you learn into an actual roadmap. You'll also need to get comfortable in the weeds of remittance advice and eligibility determination, since untangling federal versus state process is a real part of the job. The person who thrives here is a strategic thinker who's also willing to be an architect. You’re comfortable inheriting a team, evaluating what's working, and rebuilding what isn't. Your team is made up of healthcare operations staff, not necessarily college-degreed corporate hires, and you'll need to manage and grow that team as thoughtfully as you manage the roadmap. WHAT YOU'LL DO - Own state arbitration strategy end to end. Decide which states we pursue, in what order, and why. Turn a function that's been informal and reactive into a deliberate, prioritized roadmap. - Build the state filing process from the ground up. Formalize how, when, and where we file across the ~20 states with real volume, replacing ad hoc handling with a repeatable operating model. - Lead and grow the State Arbitration team. Take over management of the existing team, including direct oversight of state arbitration staff, and hire quickly to scale the function as it formalizes. - Recover misrouted claims. Identify volume currently flowing into the federal IDR process that should be filed at the state level, and build the workflows to catch and correctly route it going forward. - Partner with Data & Analytics. Work closely with the analytics team to surface trends in claims and outcomes, and use that data to sharpen which states and strategies we invest in. - Drive the product roadmap for state arbitration. Partner with Product and Engineering to translate operational reality (eligibility rules, filing requirements, remittance advice complexity) into the tools and automation the team needs. - Own remittance advice and eligibility determination. Bring clarity to where claims sit between federal and state processes, and build the judgment calls into scalable, documented logic rather than one-off decisions. - Take on broader department management. Assume ownership of responsibilities currently held by Operations leadership, running state arbitration as its own accountable department rather than a shared responsibility. WHO YOU ARE - 8–10 years of progressive management experience, with real depth in Revenue Cycle Management or an adjacent industry - Experience managing operational or administrative teams, not just corporate or credentialed hires - A track record of walking into ambiguity and building structure - Working knowledge of the payor landscape, state arbitration, and IDR entities - Comfortable with Excel and data analysis; SQL and AI tooling experience is a strong plus - Open, honest, and direct: you over-communicate by default and you trust your team while still verifying the work - A strategic thinker who's equally willing to be hands-on when a process needs to be built or rebuilt from scratch 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.