State Dispute Analyst

About Pivotal Health:

Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. Many providers face persistent underpayment from health insurance companies despite delivering high-quality care. Pivotal Health combines software, data, and service into an AI-driven platform that simplifies complex reimbursement workflows, helping providers dispute underpaid claims, reduce administrative burden, and recover the reimbursement they’re entitled to.

Our full-service IDR (Independent Dispute Resolution) 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 a State Dispute Analyst to handle the day-to-day filing and tracking of Pivotal’s state-level healthcare reimbursement disputes. You’ll prepare and submit disputes through state portals, agencies, and arbitration entities. You’ll track deadlines and fees while ensuring accurate case records from filing through resolution.

Each state runs its process differently, with its own deadlines, forms, fees, and submission rules. You’ll work from the team’s state-by-state references, follow them closely, and flag anything that looks off or has changed. You’ll sit within our dispute operations team while working with our analytics and product teams to keep case data clean.

This is a great fit for someone who is highly detail-oriented, likes fast-changing, high-volume work, and wants to build expertise in healthcare reimbursement. In this work, one missing detail can delay a provider’s payment.

What You’ll Do:

• Prepare and submit filings: Enter and submit state dispute and arbitration requests through state portals, agencies, and arbitration entities, following each state’s documentation and formatting requirements.

• Track deadlines, fees, and payments: Monitor filing and response deadlines, process fees, and confirm payers pay awarded amounts. Follow up when a payment is late or incorrect.

• Manage inbox and correspondence: Monitor shared inboxes, respond to payers, state agencies, and arbitration entities, and log next steps for each case.

• Keep case records accurate: Update internal systems and spreadsheets with case details and statuses, and close disputes only once they’re fully resolved.

• Follow state requirements: Work from state references for eligibility, deadlines, forms, and fees, and flag rule changes or gaps so the references stay current.

• Flag data issues: Tell our analytics and product teams when a case file is incomplete or inaccurate.

Who You Are:

• 2–4 years of experience in data management, operational tracking, revenue cycle operations, claims management, or insurance operations
• Experience with medical billing or coding, and comfortable reading EOBs, claims, and reimbursement codes
• Comfortable in Excel or Google Sheets, including pivot tables
• Highly detail-oriented, and catches inconsistencies in documents and data
• Manages high volume and competing deadlines accurately
• Comfortable following detailed, state-specific processes
• Clear written communicator who asks good questions and flags problems early

Extra Credit Experience:

• Familiarity with the federal No Surprises Act and how it interacts with state surprise billing laws
• Prior experience with state arbitration programs (e.g., New York, New Jersey, Texas)
• Experience with tools like Asana or Metabase or other project management tools
• Medical billing/coding certification (e.g., CPC)