Associate Manager - State Arbitration Operations

About Pivotal Health

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.

About the Role

We're looking for an Associate Manager, State Arbitration Operations to help build and operationalize Pivotal's emerging state dispute resolution function.

Today, our team supports federal Independent Dispute Resolution (IDR) under the No Surprises Act. As we expand into state-level arbitration processes, we're looking for someone who can help establish the workflows, documentation, and operational structure needed to support these programs.

Each state operates under its own rules, timelines, and negotiation processes. Some involve structured filing workflows, while others rely heavily on manual negotiation and email-based communication with health plans. This role will manage a 4-person production team handling this work, starting with Texas, Ohio, and Georgia — which are already operationalized — and support the development of repeatable processes as the program evaluates expansion across additional state markets.

This is a great opportunity for someone with experience in payer disputes, healthcare arbitration, or revenue cycle management (RCM) who is comfortable doing hands-on, manual production work now, while helping the function mature over time.

What You'll Do

• Manage the state arbitration production team: Lead and develop a 4-person team of dispute resolution coordinators responsible for manual state arbitration and IDR claim filings; drive accountability, quality, and throughput on day-to-day production work.

• Manage state negotiation workflows: Review and respond to health plan communications, evaluate settlement offers, and manage negotiation timelines to ensure disputes progress through state arbitration processes.

• Create repeatable processes: Document workflows, establish operational guidelines, and improve systems that support the state arbitration program.

• Support expansion into additional states: Help evaluate and operationalize new state arbitration markets as the team works toward decisions across the broader state IDR roster (22 total markets, with a goal of reaching pursue/not-pursue decisions on roughly 15 within 6 months).

• Oversee day-to-day operations: Provide guidance to dispute resolution coordinators responsible for managing case workflows and ensure disputes are tracked accurately.

• Bring structure to an evolving function: Help organize priorities, workflows, and team processes as the state arbitration program continues to grow.

• Partner cross-functionally: Collaborate with Product, Engineering, Finance, and Customer Success to ensure state arbitration processes integrate effectively with the broader dispute lifecycle, including flagging automation opportunities to Product — without letting those initiatives displace the manual work that needs to happen now.

Who You Are

• 5+ years of experience in healthcare operations, revenue cycle management (RCM), payer disputes, or arbitration workflows

• Genuine, hands-on experience directly managing a team as a people manager — coaching, performance management, and workflow oversight for direct reports. This is a people-management role, not a growth opportunity into management for the first time.

• Comfortable with manual, hands-on production work as a core part of the job, not just something to automate away

• Experience working with payer disputes, healthcare negotiations, or arbitration processes

• Strong analytical skills and comfort working in Google Sheets / Excel to manage case workflows and operational tracking. Experience with AI tools.

• Experience managing structured operational processes, deadlines, and case-based work streams

• Ability to bring clarity and organization to complex or evolving operational environments

• Strong written communication skills when negotiating or corresponding with health plans

Extra Credit Experience

• Experience working with state arbitration processes (Texas, Ohio, or Georgia experience a plus)

• Experience in RCM organizations or provider groups managing payer disputes

• Experience working with IDR under the No Surprises Act

• Familiarity with operational tools such as Asana, Notion, or similar systems

• Experience helping launch or operationalize new programs or workflows

Why You’ll Love Working Here

We’re a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers. While we primarily hire around our core hubs–Los Angeles and New York–we remain open to exceptional talent outside those regions. Remote and hybrid flexibility varies by role and team, and is outlined in each job description.

If you’re excited by solving complex problems and making a real-world impact, we’d love to hear from you.

Benefits Include:

• Competitive compensation, including equity

• Full health, dental, and vision coverage

• Retirement savings plan through 401(k)

• Flexible time off

• Opportunities for company-wide connection and events

Ready to Make an Impact?
We’re building something meaningful; and we want you on the team.

Bring your ideas, curiosity, and drive, and let’s transform healthcare reimbursement together.

Employment Information

Work Authorization

Candidates must be authorized to work in the United States without current or future employer sponsorship.

Equal Employment Opportunity

Pivotal Health is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate on the basis of race, color, religion, sex, gender identity or expression, sexual orientation, national origin, age, disability, veteran status, or any other legally protected status.

Reasonable Accommodations

Pivotal Health provides reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws. If you need assistance during the application or interview process, please let us know.

Background Checks

Employment is contingent upon successful completion of applicable background checks, where permitted by law.

At-Will Employment

Employment with Pivotal Health is at-will and may be terminated by either party at any time, with or without cause or notice, in accordance with applicable law.