Senior Full-Stack Engineer (Case Strategy)

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 hiring a back-end leaning Senior Full-Stack Engineer, Case Strategy to help build new products at Pivotal from the ground up. This role sits on the AI focused Case Strategy, working on new product surfaces that combine software, data, workflow design, and AI to solve high-value customer problems. We're looking for someone comfortable owning product behavior end to end while being especially strong in APIs, backend systems, data flows, and the logic that makes great products actually work.

This is a high-ambiguity, high-velocity role. You won't be handed perfectly scoped tickets or asked to maintain a mature product in a narrow lane; you'll help shape what we build, how we build it, and how quickly we can turn ideas into valuable product experiences. We're also looking for someone who is AI-first in how they work: personally fluent with AI tools, able to use them to move faster, think better, and build stronger products, and help the company get dramatically better at using AI overall.

The problems here are real, messy, and close to actual customer and business pain, not speculative side projects. This team sits at the intersection of AI, product, data, and operations, which creates unusual leverage for a strong engineer. You'll have genuine room to shape direction and use both sides of your skill set: deep backend engineering and pragmatic full-stack product development.

What You'll Do

• Build new product experiences from 0 to 1 across backend services, APIs, integrations, and frontend workflows

• Design and implement backend systems that power product logic, orchestration, data access, and AI-enabled workflows

• Contribute to frontend product development in React-based applications, especially where product quality depends on tight frontend-backend iteration

• Work closely with product, design, operations, and AI/ML partners to turn ambiguous ideas into shipped product

• Prototype quickly, then harden what works into maintainable product systems

• Build internal and customer-facing workflows that use AI, structured data, and software automation to increase leverage

• Help define product requirements through direct technical judgment, not just implementation after decisions are made

• Improve product quality through instrumentation, testing, thoughtful system design, and strong engineering hygiene

• Use AI actively in your own workflow for coding, debugging, investigation, product exploration, and iteration

• Raise the team's velocity by bringing AI-native working habits, practical engineering judgment, and strong product instincts

Who You Are

• A strong product-minded software engineer who likes building things that users feel directly

• Fullstack, but your center of gravity is backend systems and product logic

• Comfortable moving quickly in ambiguous environments and can make good decisions without waiting for perfect clarity

• High ownership mindset and enjoy driving work from rough idea to production

• Care about product quality, not just technical elegance

• An AI power user yourself, with strong judgment about how it can accelerate engineering and product development

• A clear communicator who works well with cross-functional partners

• Motivated by an environment where a great engineer can have outsized impact very quickly

Extra Credit Experience

• Strong backend experience in Python, FastAPI, or similar service-oriented systems

• Experience building product backends, APIs, integrations, and data-heavy application logic

• Experience contributing meaningfully to modern React-based frontend applications, including TypeScript and React Router/Remix-style frameworks

• Experience with PostgreSQL, SQLAlchemy, or other relational data systems

• Experience with GCP or similar cloud environments

• Experience building AI-powered products, internal tools, workflow software, or operational software

• Experience in fast-moving startup environments where engineers help define the product, not just implement it

• Experience in healthcare, fintech, logistics, or other operationally complex domains

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.