Payor Dispute Coordinator

Pivotal Health

About The Position

We’re looking for a Payor Dispute Coordinator 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 early 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 healthcare, insurance, reimbursement operations, or a similar regulated operational environment
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

Manage federal IDR case workflows: Review and prepare dispute submissions, documentation, and case tracking across the federal arbitration process.
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.
Resolve submission issues and resubmissions: Identify errors or missing documentation and coordinate corrections to ensure disputes remain compliant and on schedule.
Support operational improvements: Contribute to refining workflows and documentation as the team builds more scalable dispute management processes.