Pivotal Health
Healthcare
SeniorAppliedAI/MLEngineer,ClaimsDecisioning&Optimization
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optimal for Senior candidates.
“Senior Applied AI/ML Engineer, Claims Decisioning & Optimization at Pivotal Health. Skills: Applied AI/ML, Claims Decisioning, Optimization, Data Science, Machine Learning Engineering. Develop and deploy ML models. Design and implement AI solutions”
What You'll Achieve.
Improve claims decisioning accuracy; Optimize resource allocation; Enhance operational efficiency
Industry & Context.
Problem-solving; Analytical skills
What They're Looking For.
Must Have
5+ years of experience in applied AI/ML, Bachelor's degree in Computer Science, Statistics, Mathematics, or related field, Proficiency in Python, Experience with ML frameworks, Experience with cloud platforms, Experience with data engineering principles, Experience with SQL
Nice to Have
Master's or PhD in a quantitative field, Experience with large-scale data processing frameworks, Experience with MLOps practices, Experience with causal inference
What You'll Do.
Develop and deploy ML models
Design and implement AI solutions
Optimize decisioning processes
Build and maintain data pipelines
Collaborate with engineering teams
Conduct research on new ML techniques
Evaluate model performance
Ensure model scalability and reliability
How You'll Work.
Team & Collaboration
Cross-functional teams; Engineering teams; Product teams
Full Job Description
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. ABOUT THE ROLE Pivotal Health is investing heavily in AI as a core strategic capability to transform healthcare operations. We are building intelligent systems that automate complex workflows, improve decision-making, and drive measurable business outcomes across the organization. As a Senior Applied AI/ML Engineer focused on the Offer Engine, you will design, build, and improve production AI systems that generate optimal, fair, and defensible offers for insurance claims. 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. You will own systems end-to-end, from experimentation and model development to deployment, evaluation, and operational improvement. Your work will directly influence claim outcomes, negotiation workflows, and the
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