Senior Software Engineer - Systems Integration

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.

We're hiring a Senior Software Engineer to join Pivotal's brand new Systems Integration team, a small, backend-focused group building the infrastructure that governs how money moves through our platform. You'll be working on greenfield projects with real ownership, embedded in a team that moves fast and expects engineers to bring both technical depth and independent judgment.

If you want meaningful ownership, a strong team, and a real technical challenge, this is the role for you.

• Implement and own backend integrations: Build and maintain backend integrations with third-party systems, including ERP accounting software and Salesforce, that are core to how Pivotal handles money movement and client billing. You'll write production-quality code and take end-to-end ownership of the features you ship.
• Build the business logic behind money movement: Implement the financial calculations and business rules that determine how funds flow, from client payments through the IDR system to provider reimbursements and refunds. Precision and correctness matter here.
• Contribute to architectural decisions: Be an active participant in architectural discussions, bringing your implementation perspective and pushing back where you see a better path. Good ideas are welcome from everyone.
• Operate with autonomy on a small team: With two to three engineers per project, there's no room for passengers. You'll be expected to self-direct, identify what needs solving, and drive your work forward without waiting for detailed direction.
• Grow into broader platform work: Once the initial integration project wraps, you'll move into broader internal platform work, contributing to analytics, observability, and new product initiatives as the team and company continue to scale.

• 5+ years of software engineering experience with a strong backend focus
• Experience building and maintaining integrations with third-party APIs, financial systems, or enterprise software
• Solid understanding of backend fundamentals: system design, data modeling, API development, and service reliability
• Experience with transactional systems and distributed architecture is a plus.
• Comfortable working in greenfield environments with evolving requirements and limited hand‑holding
• Self‑directed and proactive: you identify problems and drive solutions without needing to be managed closely
• Experience in early‑stage or startup environments where organizational structure is still being built
• Strong communicator: you surface blockers early, ask good questions, and keep the team aligned

• Hands‑on experience with Salesforce or ERP integrations (e.g., Net Suite, Sage, Quick Books)
• Background in Fin Tech, payments, billing systems, or financial data
• Familiarity with accounting concepts and how financial systems are structured
• Experience contributing to architectural discussions and technical design on a small, fast‑moving team

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…