Payor Dispute Analyst

Pivotal Health•,

About The Position

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 looking for an Analyst to support Pivotal’s federal healthcare dispute resolution workflows, including Independent Dispute Resolution (IDR) processes. In this role, you’ll manage dispute cases through the federal arbitration process, ensuring claims are reviewed, submitted, and tracked accurately. Federal IDR processes require strong attention to detail and analytical thinking to evaluate eligibility, documentation, and case requirements. You’ll work closely with internal teams and external partners to ensure disputes meet regulatory guidelines and progress through the arbitration process successfully. This is a great opportunity for someone with professional experience who enjoys detail-oriented operational work and wants to develop expertise in healthcare reimbursement and regulatory processes.

Requirements

2–4 years of experience in revenue cycle operations, with focus on claims management, appeals, insurance, and reimbursement
Actively participate in team-based problem solving, knowledge sharing, and continuous improvement efforts
Engage in cross-training initiatives to build proficiency in multiple roles and functions within the team
Strong attention to detail with the ability to review documentation and identify inconsistencies or errors
Analytical thinker who can evaluate case information and determine eligibility or appropriate next steps
Comfortable working in Excel or Google Sheets to track cases and operational data
Able to manage multiple cases, deadlines, and regulatory timelines simultaneously
Strong written communication skills when coordinating with internal teams and external partners

Nice To Haves

Familiarity with Independent Dispute Resolution (IDR), arbitration, or healthcare regulatory workflows
Experience working with operational tools such as Asana, Metabase, or similar systems

Responsibilities

Evaluate dispute eligibility and documentation: Analyze claim information to ensure cases meet federal IDR requirements before submission.
Monitor arbitration timelines and correspondence: Track deadlines and review communications from health plans, arbitration entities, and internal teams to ensure cases progress appropriately.
Maintain operational tracking and documentation: Update internal systems and spreadsheets to maintain accurate case records, dispute statuses, and operational metrics.
Support operational improvements: Contribute to refining workflows and documentation as the team builds more scalable dispute management processes.