Senior Fullstack Engineer - Case Execution

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.

We're hiring a Senior Fullstack Engineer to join Pivotal's Case Execution team. This team owns critical parts of the case execution workflow, including eligibility, batching, submissions, ops workflows, and claim orchestration. These systems sit at the operational core of how Pivotal delivers outcomes for providers.

This is a strong fit for an engineer who enjoys solving complex, workflow-driven backend problems and working through data-heavy decision logic. The most technically demanding areas for this team are eligibility and batching, and the right person is energized by that kind of work rather than looking to avoid it.

What You'll Do

• Build and improve core case execution systems: Own backend development across eligibility, batching, submissions, ops workflows, and claim orchestration. These are the systems that determine how cases move through Pivotal's platform and reach resolution.

• Tackle complex, data-driven backend problems: Work through the decision logic and data-heavy workflows that make eligibility and batching hard, understanding not just how individual systems work, but how they interact across the broader platform.

• Contribute to workflow orchestration: Build and improve the systems that coordinate how cases are staged, routed, and executed end to end, with a clear eye toward correctness and reliability.

• Collaborate cross-functionally: Work closely with the Integrations team, Case Strategy team, and other engineering and product partners to ensure systems are well-connected and aligned with how the broader platform operates.

• Contribute to front-end and admin workflows: The role is primarily backend-focused, but you'll contribute to internal-facing UI and ops tooling where the product requires it.

Who You Are

• 5+ years of fullstack software engineering experience with a backend focus

• Strong engineering fundamentals with hands-on experience building data-heavy, workflow-oriented systems

• Experience working on complex, data-driven decision logic or orchestration problems: you're comfortable with systems where correctness and sequencing both matter

• Experience contributing to modern React-based applications

• Comfortable operating in a collaborative, fast-moving startup environment where ownership and requirements evolve

• Python experience; able to work effectively in a Python-based backend environment

• Self-directed and proactive: you identify problems and drive them to resolution without heavy oversight

• Strong communicator who collaborates well across engineering, product, and adjacent teams

Extra Credit If You Have

• Experience with healthcare-specific data or HealthTech systems

• Exposure to data-heavy architectures or problems adjacent to data engineering without being a pure data engineer

• Familiarity with tools like Snowflake, dbt, or Databricks

What Success Looks Like

• You can navigate complex eligibility and batching logic and make sound decisions in ambiguous technical territory

• You're comfortable owning workflow-heavy backend systems end to end

• You partner effectively with engineering, product, and adjacent teams without needing heavy coordination overhead

• You bring strong judgment to evolving technical problems and help the team move faster as a result

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.