Senior Manager, State IDR

Pivotal Health•,

5d•$150,000 - $170,000

About The Position

Pivotal Health is seeking a Senior Manager to lead and formalize its State Arbitration function. This role involves developing strategy, operations, and execution for state arbitration, building it into a standalone department. The Senior Manager will own the full lifecycle of state arbitration, including deciding which states to pursue, formalizing filing processes, and recovering misrouted claims. This position requires a strategic thinker who is also willing to be hands-on in building and rebuilding processes. The role involves managing a team of healthcare operations staff and partnering with Data & Analytics and Product & Engineering teams to drive the product roadmap. The Senior Manager will also be responsible for remittance advice and eligibility determination, bringing clarity to federal versus state processes and building scalable logic. Pivotal Health is a technology platform that helps healthcare providers get paid fairly by simplifying complex reimbursement workflows, including Independent Dispute Resolution (IDR). Their AI-driven platform combines software, data, and service to help providers dispute underpaid claims and recover owed reimbursement efficiently.

Requirements

8–10 years of progressive management experience, with real depth in Revenue Cycle Management or an adjacent industry.
Experience managing operational or administrative teams, not just corporate or credentialed hires.
A track record of walking into ambiguity and building structure.
Working knowledge of the payor landscape, state arbitration, and IDR entities.
Comfortable with Excel and data analysis.
Open, honest, and direct communication style.
A strategic thinker who's equally willing to be hands-on when a process needs to be built or rebuilt from scratch.

Nice To Haves

SQL and AI tooling experience is a strong plus.

Responsibilities

Own state arbitration strategy end to end, deciding which states to pursue, in what order, and why.
Build the state filing process from the ground up, formalizing how, when, and where to file across states with significant volume.
Lead and grow the State Arbitration team, including direct oversight and hiring to scale the function.
Recover misrouted claims currently flowing into the federal IDR process that should be filed at the state level.
Partner with Data & Analytics to surface trends in claims and outcomes to inform state and strategy investments.
Drive the product roadmap for state arbitration by partnering with Product and Engineering to translate operational realities into tools and automation.
Own remittance advice and eligibility determination, bringing clarity to federal versus state processes and building scalable, documented logic.
Assume ownership of responsibilities currently held by Operations leadership, running state arbitration as its own accountable department.