Lead, State Arbitration

recoursehealth.com•San Francisco, CA

About The Position

Twenty states run their own arbitration programs. Nobody has figured them all out. That's the job. A federal arbitration system called Independent Dispute Resolution, or IDR, now determines billions of dollars in healthcare payments each year. Providers win the vast majority of disputes, yet most eligible claims are never filed. The process is manual, fragmented, and resource-intensive, and most providers don't have the infrastructure to pursue what they're owed. The No Surprises Act created the federal framework. But a significant share of out-of-network disputes never touch it, because roughly twenty states run their own arbitration programs with their own rules, their own filing windows, their own arbitrator networks, and their own quirks. Most of the industry ignores this. Claims that should be filed at the state level get pushed into the federal process where they lose on eligibility, or they get written off entirely. That's money on the floor, and it's a market almost nobody has systematically claimed. There is no manual for this. Every state is its own puzzle. The statute says one thing, the agency guidance says another, the actual filing portal behaves a third way, and the only way to know what really happens is to file and find out. You'll need to read primary sources, talk to state agencies, figure out how a program actually operates, and then turn that into something repeatable that the rest of the team can execute without becoming an expert themselves. The reward is that this compounds fast. Every state you crack becomes a durable advantage, because the next company has to do the same work from scratch. And unlike federal IDR, where everyone is now competing, most of these programs are wide open.

Requirements

4+ years in a role that rewards regulatory research, compliance analysis, claims operations, or policy work
Demonstrated ability to read primary legal or regulatory sources and translate them into operational guidance
Comfort with data and analytical tools. You can size an opportunity yourself before committing to a state
Hands-on fluency with AI tooling. You have used it to ship or accelerate real work, not just tried the demos
Clear written communication. Your output is documentation other people rely on
A preference for small teams and early-stage chaos over mature org charts
Sound judgment, research depth, and ownership mindset are required.
Grit matters more than pedigree.

Nice To Haves

healthcare revenue cycle
out-of-network claims
No Surprises Act
state insurance regulation
arbitration experience
Paralegal, compliance, or health policy backgrounds are welcome.

Responsibilities

Decide which states we pursue, in what order, based on volume, rules, and how winnable they are
Research state statutes, regulations, agency guidance, and arbitration procedures, and figure out what they actually mean operationally
Build the filing process for each state you take on, from eligibility criteria through submission and follow-through
Identify claims currently defaulting into the federal process that belong at the state level, and build the routing logic to catch them
Turn your research into clear instructions and workflows the rest of the team can follow without becoming state-law experts
Partner with engineering to encode state-specific rules into the platform rather than living in your head
Own outcomes: filing volume, win rate, and recovery for every state program you stand up

Benefits

institutional backing
shared platform team spanning engineering, strategy, design, and back-office
early access to large provider systems
funded, validated opportunity with real customers and real data
small, nimble team
move quickly
value clarity over theater
best work of your career
people who raised your game
something that mattered
clear thinking
high ownership
intellectual honesty
direct communication
operations, product, and engineering should operate as one pod, not three functions
machines to do machine work, and the humans to do their best work
unusual latitude
strategy is genuinely yours to set
most memorable stretch of your career
shipped something real
team you respected
domain that actually matters