Pivotal Health

Pivotal Health

Senior Applied AI/ML Engineer, Claims Decisioning & Optimization

Lower Manhattan, NY · Senior · Contract

No sponsorshipDetected 42 days ago
Machine LearningA/B TestingNegotiationResearch

About the role

  • Pivotal Health is investing heavily in AI as a core strategic capability to transform healthcare operations.
  • Reporting to the Head of AI/ML Engineering, you will work at the intersection of machine learning, software engineering, product workflows, and business strategy to solve complex decision-making problems at scale.
  • This role is focused on applied AI engineering-not research in isolation.

Responsibilities

  • Own and improve production AI systems. Design, deploy, and optimize AI/ML solutions that influence critical claims and negotiation workflows.
  • Build offer optimization models. Develop and improve models that generate optimal, fair, and explainable offers while balancing business objectives, customer outcomes, and operational constraints.
  • Develop AI-powered decisioning systems. Build and refine production workflows involving generation, retrieval, evaluation, orchestration, and automated decision-making.
  • Design evaluation and experimentation frameworks. Create robust testing methodologies and experiments that improve model quality, workflow performance, and business outcomes.
  • Translate business problems into scalable systems. Partner with product, operations, and engineering teams to define success metrics and convert complex requirements into production-ready solutions.
  • Optimize model and workflow behavior. Improve prompts, retrieval strategies, model performance, and decisioning logic through continuous experimentation and feedback loops.
  • Drive engineering excellence. Contribute to architecture, observability, testing, rollout safety, and operational reliability across AI-powered systems.
  • Balance speed with rigor. Deliver impactful systems quickly while maintaining high standards for reliability, fairness, and maintainability.
  • Own and improve production AI systems.
  • 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.

Requirements

  • 5-8+ years of experience building software systems in production environments, with a strong track record of owning and delivering complex technical solutions.
  • Proven ability to translate complex operational requirements and real-world data into reliable, shipped products.

Nice to have

  • Understanding of marketplace dynamics and optimization-driven businesses such as ad tech, lending, credit decisioning, or revenue management.
  • Familiarity with explainable AI techniques and systems where fairness, transparency, and defensibility are critical considerations.
  • This position is not eligible for employer-sponsored work authorization.
  • Applicants must be legally authorized to work in the United States on a permanent basis without the need for current or future visa sponsorship.*
  • While we primarily hire around our core hubs-Los Angeles and New York-we remain open to exceptional talent outside those regions.
  • If you're excited by solving complex problems and making a real-world impact, we'd love to hear from you.
  • Opportunities for company-wide connection and events
  • Ready to Make an Impact?

Compensation

  • Competitive compensation, including equity

Benefits

  • Competitive compensation, including equity
  • Full health, dental, and vision coverage
  • Retirement savings plan through 401(k)
  • Flexible time off
  • 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.
  • 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.
  • We're building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey.
  • Experience building and operating applied AI, machine learning, LLM, agentic, or decisioning systems in production.

Equal 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

Visa & Work Authorization

  • Candidates must be authorized to work in the United States without current or future employer sponsorship.
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This listing is sourced directly from Pivotal Health's careers page and normalized into a canonical job model.