Senior Applied AI/ML Engineer, Claims Decisioning & Optimization

About Pivotal Health 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. 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. 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. Our full-service IDR solution is just the starting point. We’re building solutions that enable providers to operate with clarity, control, and confidence across the reimbursement journey. Summary We’re hiring a Senior Applied AI/ML Engineer to build and improve high-impact AI systems that sit directly in important product and operational workflows. This role reports to the Head of AI/ML Engineering and is designed for someone who wants to work on applied systems, not research in isolation. You’ll operate at the intersection of models, software, product workflows, and business outcomes. You will work on building models that produce optimal, fair, and defensible offers for insurance claims. We are looking for product-oriented applied engineers who can move quickly, own meaningful surfaces, and turn ambiguous opportunities into shipped systems with measurable value. Some candidates may come from a classic ML engineering path. Others may come from data science-heavy environments where experimentation, optimization, decisioning, or marketplace dynamics were central. We’re open to both, as long as you are excited to ship. We also want someone who is AI-first in their own work. The right person will use AI actively in engineering, analysis, iteration, debugging, and experimentation, and will help the team build a strong AI-native way of working. What You'll Do Own and improve applied AI and ML systems that influence important business workflows. Design, train, and deploy models that generate optimal, fair, and explainable offers for claims, balancing business objectives with fairness constraints. Build and refine production workflows around generation, decisioning, retrieval, evaluation, and orchestration. Work on concrete systems such as position statement generation, offer engine improvements, open negotiation agents, and configurable rules or decisioning systems. Design and run experiments that improve model quality, workflow quality, and business outcomes. Partner with product, operations, and engineering teammates to define success metrics and translate messy real-world problems into buildable systems. Improve prompt, model, and workflow behavior through tight feedback loops and practical iteration. Contribute to the engineering quality of these systems, including instrumentation, testing, rollout safety, and operational visibility. Use AI as a force multiplier in your own work and help the team move faster by bringing strong AI-native habits. Balance speed and rigor in an environment where shipping matters and iteration is constant. Who You Are In the first 6 to 12 months, strong outcomes in this role would include: Measurable improvements in the quality, fairness, and defensibility of offers generated for claims. Making clear improvements to position statement generation, offer engine behavior, open negotiation workflows, or related AI systems Designing and running high-value experiments with real product or business impact Reducing failure modes and increasing confidence in production AI workflows Helping create stronger feedback loops between model behavior, operational workflows, and business outcomes Becoming a trusted technical owner for an important applied AI surface Contributing to a team culture that is both highly practical and highly capable with AI Nice To Haves Experience building optimization systems for pricing, bidding, or equitable decisioning. Experience with applied ML, LLM systems, agent workflows, or decisioning systems in production Experience designing and interpreting experiments, evals, or optimization loops Experience in domains like marketplaces, pricing, ad tech, credit decisioning, lending, or revenue optimization Why You’ll Love Working Here We’re a collaborative, low-ego team on a mission to make healthcare reimbursement fairer for providers. While we primarily hire around our core hubs–Los Angeles and New York–we remain open to exceptional talent outside those regions. Remote and hybrid flexibility varies by role and team, and is outlined in each job description. If you’re excited by solving complex problems and making a real-world impact, we’d love to hear from you . Benefits Include: 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 Ready to Make an Impact? We’re building something meaningful; and we want you on the team. Bring your ideas, curiosity, and drive, and let’s transform healthcare reimbursement together . Employment Information Work Authorization Candidates must be authorized to work in the United States without current or future employer sponsorship. Equal Employment 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 Pivotal Health provides reasonable accommodations for qualified individuals with disabilities in accordance with applicable laws. If you need assistance during the application or interview process, please let us know. Background Checks Employment is contingent upon successful completion of applicable background checks, where permitted by law. At-Will Employment Employment with Pivotal Health is at-will and may be terminated by either party at any time, with or without cause or notice, in accordance with applicable law.