Senior SWE - HealthTech Startup | Python & Orchestration

This Senior Software Engineer role at Pivotal Health offers strong career development signals for backend engineers who want meaningful ownership in a high-growth Health Tech startup
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Compensation context: No salary range is listed, which can indicate negotiation flexibility but also opacity. Senior backend engineers in NYC typically command $160K–$220K+ in base salary at VC-backed startups. Equity is included, which adds upside if Pivotal captures the large and growing IDR/claims market.

Skills you'll build:

• Complex workflow orchestration and state machine design — highly transferable to fintech, insurtech, and enterprise SaaS
• Data-heavy backend engineering in Python — one of the most in-demand skill sets in 2024–2025
• Healthcare domain expertise (IDR, claims, eligibility) — a niche with regulatory tailwinds and limited supply of experienced engineers
• Cross-functional collaboration patterns common to product-led growth companies

Culture signals: The language around "low-ego," "collaborative," and "fast-moving startup" suggests an early-to-mid-stage company with flat hierarchy. The team structure (Case Execution, Integrations, Case Strategy) implies some organizational maturity beyond pure seed stage.

Green flags: Clear technical problem definition, ownership culture, equity upside, and a real-world mission.
Watch for: No salary transparency, at-will employment language, and ambiguity around remote flexibility may warrant clarifying questions before accepting an offer.

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.

We're hiring a Senior Software Engineer to join Pivotal's Case Execution team. This team owns critical parts of the case execution workflow, including eligibility, batching, submissions, ops workflows, and claim orchestration. These systems sit at the operational core of how Pivotal delivers outcomes for providers.

This is a strong fit for an engineer who enjoys solving complex, workflow-driven backend problems and working through data-heavy decision logic. The most technically demanding areas for this team are eligibility and batching, and the right person is energized by that kind of work rather than looking to avoid it.

Build and improve core case execution systems: Own backend development across eligibility, batching, submissions, ops workflows, and claim orchestration. These are the systems that determine how cases move through Pivotal's platform and reach resolution.

Tackle complex, data-driven backend problems: Work through the decision logic and data-heavy workflows that make eligibility and batching hard, understanding not just how individual systems work, but how they interact across the broader platform.

Contribute to workflow orchestration: Build and improve the systems that coordinate how…