Senior Fullstack Engineer - Product Platform Engineering

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.

The product platform is the layer other product teams build on. Today that means identity and access, including customer SSO, invitations, and sessions; the organization and tenancy model; the shared services, APIs, and schemas that carry customer data between products; and the developer experience, including the tooling and agent workflows engineers use to ship. The scope grows whenever product teams need a capability that should be built once. Role-based access control, email infrastructure, the production path for the models our products depend on, and likely data ingress are next in line. When this layer is right, product teams move faster and customers have a better experience.

This role is for engineers who think deeply about systems and can explain why a solution works as well as how to build it. You'll own components and services within the platform end to end, partner closely with product engineering, data, and infrastructure teams, and make the architectural decisions that keep the platform reliable and extensible as the business takes on more customers and more complexity. Expect us to ask about a system you built: who used it, why they cared, and what you would have built differently had you understood that sooner.

• Own platform components end to end: Design, build, and operate services, libraries, and schemas within the platform, from design through production, with clear ownership of their reliability and evolution.

• Design for extension and reuse: Build composable abstractions and well-defined interfaces so product teams can extend the platform without forking it or waiting on you.

• Design scalable, reliable system interactions: Contribute to the design of system interactions and data flows, making architectural decisions that balance scalability, reliability, security, and performance as the platform evolves.

• Improve reliability and operational signal: Build and evolve monitoring, alerting, dashboards, and testing pipelines that surface meaningful signal rather than noise.

• Reduce toil: Identify repeating patterns across teams and make them composable through better abstractions or new tooling, including AI-assisted tooling where it helps.

• Partner with product teams: Work as an embedded partner to feature teams, unblock delivery, and make sure platform decisions reflect what those teams actually need.

• 5+ years of experience in fullstack, backend or platform software engineering

• Strong software engineering foundation with solid coding skills; Python preferred

• Hands-on experience designing and operating cloud-native systems; GCP preferred

• Experience with relational databases and data modeling, including schema evolution in production

• Familiarity with event-driven architectures (Kafka, Pub/Sub, Kinesis, or similar)

• Range to move between domains such as authorization, messaging infrastructure, and data pipelines without needing each to be familiar first

• Strong product instincts: you judge a system by whether it is useful and correct, and elegance comes second

• You want to know why a customer cares before you build, and you go find out: from product, from support, from the customer directly

• Self-directed and proactive: you identify problems and drive them to resolution without heavy oversight

• Comfortable in greenfield environments with evolving requirements and ambiguous ownership

• Low-ego and collaborative by default: direct, open to feedback, and more interested in shipping great work than in being right

• Identity and access systems (OIDC, SAML, SSO, sessions) or authorization models such as RBAC

• Transactional email or messaging infrastructure, including deliverability and bounce handling

• Data ingestion pipelines, or the tooling that moves ML models from experiment to production

• Internal libraries, SDKs, or developer tooling that other teams adopted

• Automation or AI-assisted tooling that reduced operational toil

• TypeScript and React, enough to work across the products the platform serves

• Startup or early-stage experience where engineers own outcomes rather than tickets

• FinTech, HealthTech, or other regulated industries

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.

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.