Refunds & Payor Compliance Analyst

Pivotal Health; Williamsburg (VA); Hybrid; USD 60,000 - 75,000; Full time

Benefits offered by this job

Equity

Health, dental, and vision coverage

401(k)

Flexible time off

Company-wide events

Job summary

Pivotal Health is seeking an Accounts Payable Analyst to support the Payor Compliance team with payment processing and refunds. You will own the weekly fee-refund cycle, answer refund inquiries, and maintain Payor Compliance documentation.

You’ll work in Metabase and BigQuery to reconcile payments and refunds and act as the main contact for refund questions from Client Success. This role blends data, processes, and client impact, offering exposure to NSA IDR concepts and opportunities to shape

Qualifications

• 2–3 years of experience in healthcare operations or related field.
• Ability to pull and interpret reports in Metabase/BigQuery; basic SQL is a plus.
• Strong written communication for explaining payment and refund issues.
• Detail-oriented, organized, and able to manage high-volume refund cycles.
• Proficient with Excel/Google Sheets and data tracking for claims.
• Collaborative, proactive communication with teams to resolve blockers.
• Analytical thinker identifying root causes in payor data.

Responsibilities

• Run the weekly refund cycle and process refunds with precise matching.
• Field refund inquiries and track status using dashboards and tools.
• Build and maintain relationships with IDREs to expedite refunds.
• Coordinate between Client Success, IDREs, Operations, and Accounting.
• Develop and implement new Payor Compliance processes.
• Maintain and improve Payor Compliance SOPs and document patterns.
• Flag platform issues and escalate with evidence to engineering.

Skills

Healthcare operations

Data analysis

SQL basics

Excel

Written communication

Tools

Metabase

BigQuery

SQL

Job description

Pivotal Health is seeking an Accounts Payable Analyst to support the Payor Compliance team with payment processing and refunds. You will own the weekly fee-refund cycle, answer refund inquiries, and maintain Payor Compliance documentation.

You’ll work in Metabase and BigQuery to reconcile payments and refunds and act as the main contact for refund questions from Client Success. This role blends data, processes, and client impact, offering exposure to NSA IDR concepts and opportunities to shape