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Pivotal Health is a technology platform helping healthcare providers navigate complex reimbursement disputes and recover underpaid claims through an AI-driven, full-service solution. The company combines software, data, and service to simplify Independent Dispute Resolution (IDR) workflows and reduce administrative burden on provider teams.
In this role, you will serve as a State Dispute Analyst, handling day-to-day filing and tracking of state-level healthcare reimbursement disputes. Your core responsibilities include:
• Preparing and submitting dispute filings through state portals, agencies, and arbitration entities, ensuring compliance with each state's unique documentation and formatting requirements
• Tracking filing deadlines, response deadlines, processing fees, and confirming that payers remit awarded amounts; following up on late or incorrect payments
• Managing shared inboxes and correspondence with payers, state agencies, and arbitration entities, logging next steps for each case
• Maintaining accurate case records in internal systems and spreadsheets, updating case details and statuses through full resolution
• Working from state-by-state reference materials to ensure compliance with eligibility, deadline, form, and fee requirements; flagging rule changes or gaps
• Identifying and escalating data issues to analytics and product teams when case files are incomplete or inaccurate
This role sits within the dispute operations team and requires close collaboration with analytics and product teams to maintain data integrity. You'll work in a fast-paced, high-volume environment where attention to detail directly impacts provider payment timelines.
REQUIREMENTS:
• 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations
• Experience with medical billing or coding; comfortable reading EOBs, claims, and reimbursement codes
• Proficiency in Excel or Google Sheets, including pivot tables
• Highly detail-oriented with ability to catch inconsistencies in documents and data
• Ability to manage high volume and competing deadlines accurately
• Comfort following detailed, state-specific processes
• Clear written communication skills with ability to ask clarifying questions and flag problems early
EXTRA CREDIT:
• Familiarity with the federal No Surprises Act and state surprise billing laws
• Prior experience with state arbitration programs (e.g., New York, New Jersey, Texas)
• Experience with project management tools (Asana, Metabase, etc.)
• Medical billing/coding certification (e.g., CPC)
