Optimization Analyst (Eligibility Focus)

Company

Pivotal Health

Where

Williamsburg, NY

Level

Mid

First seen

October 3, 2026

Listed via

Ashby

What the posting says

You'll be the team's first Optimization Analyst and the first point of intake for payor eligibility inquiries. The problem you'll work on: fragmented eligibility data lets claims flow into IDR that are later deemed ineligible, which generates fees and default determinations. Payors flag claims as ineligible for federal IDR (In Network, Non-NSA, government plans), sometimes as a whole batch in a cease-and-desist email, and our product defaults some claims to Ineligible on its own. You'll review each flag, separate the truly ineligible claims from the product defaults that need correcting, run…

Read more and apply on Pivotal Health's site

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