Senior Manager, State IDR

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 State arbitration is a growing and increasingly important part of our business, and it has reached the point where it needs a dedicated leader driving strategy, operations, and execution. We’re hiring a Senior Manager to build state arbitration into a formal, standalone function with its own strategy, workflows, and team. You’ll inherit the State Arbitration team directly, take on management scope currently sitting with our VP of Operations, and own the department end to end. You'll own the full lifecycle of state arbitration: which of the ~20 states with meaningful volume we pursue and when, how we build and formalize the filing process in each, and how we recover claims currently defaulting into the federal process that should be filed at the state level instead. You'll partner closely with Data & Analytics to spot trends before they're obvious, and with Product & Engineering to turn what you learn into an actual roadmap. You'll also need to get comfortable in the weeds of remittance advice and eligibility determination, since untangling federal versus state process is a real part of the job. The person who thrives here is a strategic thinker who's also willing to be an architect. You’re comfortable inheriting a team, evaluating what's working, and rebuilding what isn't. Your team is made up of healthcare operations staff, not necessarily college-degreed corporate hires, and you'll need to manage and grow that team as thoughtfully as you manage the roadmap. WHAT YOU'LL DO - Own state arbitration strategy end to end. Decide which states we pursue, in what order, and why. Turn a function that's been informal and reactive into a deliberate, prioritized roadmap. - Build the state filing process from the ground up. Formalize how, when, and where we file across the ~20 states with real volume, replacing ad hoc handling with a repeatable operating model. - Lead and grow the State Arbitration team. Take over management of the existing team, including direct oversight of state arbitration staff, and hire quickly to scale the function as it formalizes. - Recover misrouted claims. Identify volume currently flowing into the federal IDR process that should be filed at the state level, and build the workflows to catch and correctly route it going forward. - Partner with Data & Analytics. Work closely with the analytics team to surface trends in claims and outcomes, and use that data to sharpen which states and strategies we invest in. - Drive the product roadmap for state arbitration. Partner with Product and Engineering to translate operational reality (eligibility rules, filing requirements, remittance advice complexity) into the tools and automation the team needs. - Own remittance advice and eligibility determination. Bring clarity to where claims sit between federal and state processes, and build the judgment calls into scalable, documented logic rather than one-off decisions. - Take on broader department managemen…