[Hiring] IDR Analyst @Pivotal Health

Role Description

We’re looking for an IDR Analyst to support Pivotal’s healthcare dispute resolution workflows, including Independent Dispute Resolution (IDR) processes. In this role, you’ll manage dispute cases through the arbitration process, ensuring claims are reviewed, submitted, and tracked accurately.

This role sits within a broader dispute operations team that owns both federal and state-level reimbursement disputes. Your assigned area may include:

• Federal IDR processes
• State-specific dispute and arbitration processes

The work requires strong attention to detail and analytical thinking to evaluate eligibility, documentation, and case requirements. You’ll work closely with internal teams and external partners — such as IDREs (Independent Dispute Resolution Entity) for federal cases, or the relevant state arbitration entities and agencies for state cases — to ensure disputes meet the applicable regulatory guidelines and progress through the arbitration process successfully.

This is a great opportunity for someone with professional experience who enjoys detail-oriented operational work and wants to develop deep expertise in healthcare reimbursement and regulatory processes.

If your focus is federal IDR, you’ll build fluency in our established workflows and steadily take on more independent judgment calls and a real say in how the process evolves. If your focus includes state-specific disputes, you’ll need to independently research the relevant state laws, regulations, agency guidance, payer requirements, and arbitration procedures.

What You’ll Do

• Evaluate dispute eligibility and documentation:
  • Analyze claim information to ensure cases meet federal IDR or state-specific dispute requirements before submission.
• Research and interpret state regulatory requirements:
  • Independently research state laws, regulations, agency guidance, payer requirements, and arbitration procedures; interpret how they apply operationally; and translate that research into clear, reliable instructions and workflows for the rest of the team.
• Own inbox and correspondence review:
  • Monitor shared inboxes and respond to incoming emails from payors and IDR entities, tracking follow-ups and next steps for each case.
• Ensure accurate case closures:
  • Confirm disputes are closed only when truly resolved, catching premature or missed closures before they affect reimbursement.
• Monitor arbitration timelines and correspondence:
  • Track deadlines and review communications from health plans, arbitration entities, and internal teams to ensure cases progress appropriately.
• Maintain operational tracking and documentation:
  • Update internal systems and spreadsheets to maintain accurate case records, dispute statuses, and operational metrics.
• Support operational improvements:
  • Contribute to refining workflows and documentation as the team builds more scalable dispute management processes, and flag documentation or system issues to our analytics and product teams when case files are incomplete or inaccurate.

Qualifications

• 2–4 years of experience in revenue cycle operations, claims management, or reimbursement/insurance operations
• Experience with medical billing or coding; comfortable reading EOBs, claims, and reimbursement codes
• Comfortable working in Excel or Google Sheets, including building and using pivot tables, to track cases and data
• Strong attention to detail and analytical thinking; ability to review documentation, catch inconsistencies, and determine next steps
• Ability to manage a high volume of competing deadlines with strong written communication
• Comfortable exercising judgment and asking thoughtful questions rather than waiting for every next step to be prescribed; able to make well-supported recommendations and grow into more independent ownership of your day to day

Extra Credit

• Familiarity with Independent Dispute Resolution (IDR), arbitration, or healthcare regulatory workflows
• Experience working with operational tools such as Asana, Metabase, or similar systems
• Medical billing/coding certification (e.g., CPC) or other formal coding training
• Knowledge of state-level IDR regulations in addition to federal requirements

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