Healthcare Payor Optimization Analyst

Pivotal Health; New York (NY); Hybrid; USD 75,000 - 115,000; Full time

Benefits offered by this job

Competitive compensation

Health, dental, and vision coverage

401(k)

Flexible time off

Company-wide events

Job summary

Pivotal Health, a leading AI-driven repayment platform, is hiring an Optimization Analyst to support the Payor Optimization team. You’ll triage CS escalations, pull claims data from Metabase, and help close the loop on underpaid reimbursements.

You’ll engage with clients, success teams, and payors to uncover root causes, document action plans, and improve processes. Excel and data storytelling are essential.

Qualifications

• 1–3 years in healthcare operations or related fields.
• Strong Excel skills including pivot tables.
• Excellent communication and client-facing abilities.

Responsibilities

• Be the go-to for Client Success on payor compliance questions and tickets.
• Lead deep-dive payor reviews to identify blockers and document findings.
• Shape outreach to payors, manage inboxes, and track responses.
• Develop CS-facing materials and SOPs as workflows evolve; identify patterns for bigger wins.

Skills

Excel

Pivot tables

Communication

Tools

Metabase

Power BI

Asana

Notion

Job description

Pivotal Health, a leading AI-driven repayment platform, is hiring an Optimization Analyst to support the Payor Optimization team. You’ll triage CS escalations, pull claims data from Metabase, and help close the loop on underpaid reimbursements.

You’ll engage with clients, success teams, and payors to uncover root causes, document action plans, and improve processes. Excel and data storytelling are essential.