Staff Software Engineer - Systems Intergration

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

We're hiring a Staff Software Engineer to join Pivotal's brand new Systems Integration team, a small, technical group focused on how money moves through our platform and into the hands of the providers we serve. This is a greenfield role with real architectural ownership: you'll be building integrations from scratch, making foundational technical decisions, and setting the patterns the team will build on for years to come.

If you want to work on a hard problem with a strong team, real ownership, and room to grow, this is it.

What You'll do

• Lead the architecture and build of greenfield integrations: Design and implement our ERP and Salesforce integrations from the ground up. You'll make the foundational architectural decisions, evaluate tradeoffs, and document the reasoning behind them, building systems that are scalable, maintainable, and fit for a fast-growing platform.

• Own the technical direction for money movement logic: Build the business logic that determines how funds are calculated and distributed: how much goes to the client, how much flows through the IDR system, and how refunds are handled after billing. This is core infrastructure with direct financial impact.

• Drive technical decision-making and documentation: As a technical leader on a small team, you'll be expected to define standards, write supporting documentation, and ensure the team's technical decisions are clearly reasoned and well-recorded. You set the bar for how the team builds.

• Stay hands-on: This is not an ivory tower architecture role. You'll be writing production code, reviewing your team's work, and staying close to the implementation throughout the project lifecycle.

• Grow with the team: Staff Engineers are expected to be tech leads of their respective project workstreams. You'll have the opportunity to shape not just the codebase, but the team structure itself.

Who you are

• 7+ years of software engineering experience with a strong backend focus

• Proven track record of owning architectural decisions on complex, production systems

• Experience building integrations with third-party platforms: ERPs, CRMs, financial systems, or similar

• Strong understanding of financial or payments systems: you understand how money moves and what correctness means in that context

• Experience with transactional systems and distributed architecture is a plus.

• Comfortable in greenfield environments: you can operate without established playbooks and make sound decisions in ambiguity

• Self-directed and highly communicative: on a small team, you don't wait to be told what to do next

• Startup or early-stage experience: you understand what it means to build in an environment where organizational infrastructure is still taking shape

Extra credit if you have

• Direct experience with Salesforce or ERP integrations (e.g., NetSuite, Sage, QuickBooks)

• Background in FinTech, payments, or billing systems

• Experience growing into or functioning as a tech lead on a small, fast-moving engineering team

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.