Optimization Analyst

Pivotal Health

$70K — $95K *
Healthcare
Less than 5 years of experience
Job Overview by Ladders

Qualifications

  • 1-3 years of experience in healthcare operations, revenue cycle, managed care, consulting, or analyst role in finance or healthcare.
  • Proficient in Excel, including advanced functions like pivot tables.
  • Strong customer service instincts with excellent interpersonal skills.
  • Clear and confident written communication skills for effective storytelling.
  • Detail-oriented and organized, capable of managing multiple tasks efficiently.

Responsibilities

  • Serve as the primary contact for Client Success regarding payor compliance inquiries.
  • Conduct in-depth investigations into payor blockages and document findings.
  • Manage outreach campaigns and maintain effective communication with payors.
  • Develop and refine materials for Client Success and update SOPs as necessary.
  • Identify patterns in data that lead to process improvement and operational wins.

Benefits

  • 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.
Full Job Description
About the Role

We're looking for an Optimization Analyst to help with our fast growing team!

Our Payor Optimization team sits between our clients, Client Success, and payors-working to ensure providers receive accurate and timely reimbursement following IDR determinations. Our rapidly growing business is hiring an analyst to triage CS escalations and close the loop on claims that need follow-through.

With rapid scale comes rapid growth. This means real greenfield: low-hanging fruit you can knock out for quick wins, processes that don't exist yet, and a direct hand in shaping what payor compliance looks like as it matures. The IDR world comes with a learning curve; we'll teach you that part. What we can't teach is curiosity, data instincts, and the people skills to work a problem across teams. We look forward to hearing from you!

What You'll Do
  • Be the go-to for Client Success: When CS has a payor compliance question, you're their person, on tickets and on calls. You'll own the daily flow of the Asana Payor Compliance queue, dig into the client and payor situations CS flags, and pull claims data from Metabase to uncover the real root cause.
  • Lead deep-dive payor reviews: You'll investigate payors to find what's actually blocking payment, whether it's routing issues, INN processing, or eligibility gaps. Then you'll document what you learn and communicate a plan through data storytelling.
  • Be our voice with payors: Working from the team's analysis, you'll serve as our first point of contact on outreach campaigns. That means prepping emails, managing payor inboxes, tracking responses and keeping the Payor Outreach Tracker fresh at every milestone.
  • Shape the playbook: You'll build CS-facing materials, sharpen our SOPs as workflows evolve, and spot the patterns that turn into bigger wins. Around here, small, consistent wins compound, and you'll be the one stacking them.
Who You Are
  • You've spent 1 to 3 years in healthcare operations, revenue cycle, managed care, consulting (highly preferred), or an analyst role in finance or healthcare.
    • Excel is home turf, pivot tables included.
  • People energize you. You're warm, personable, and quick to build trust, with genuine customer-service instincts in every conversation with CS and payors.
  • You write with clarity and confidence. Your findings and rationale become the language CS takes straight to clients.
  • You're the reliable one: detail-oriented and organized under volume, following every thread to the finish even with a full ticket queue and multiple reviews in motion.


Extra Credit Experience
  • Familiarity with the No Surprises Act, the NSA IDR process, or health insurance TPA/payor structures
  • SQL, data storytelling, or dashboard know-how in Metabase, Power BI, or similar
  • Comfort with Asana, Notion, or similar workflow tools


Why You'll Love the Role
  • Be here for the beginning: You'll be the first analyst on a growing team, with low-hanging fruit ready for quick wins from day one.
  • Your work pays off - literally: What you find determines whether clients collect on legitimate IDR claims.
  • Grow with a great team behind you: You'll partner closely with the Payor Optimization Strategist and a genuinely strong Client Success org, at a company invested in developing its analysts.
  • Bottom Line: If you love people, get jazzed working with data and have a passion for building out awesome processes, this is the role for 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.

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