Senior Full Stack Engineer - Integrations

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 Full Stack Engineer to join Pivotal's Integrations team. You'll build the backend systems that connect Pivotal's platform to external healthcare data sources, billing tools, and partner APIs, while also owning the frontend surfaces that expose integration status, configuration, and data to internal teams and customers.

This is a full-ownership role on a small, fast-moving team that is still defining itself. The work is backend-leaning, most of what you build will be services, pipelines, and APIs handling real-world healthcare data, but you'll also build the UI that makes integration health, mapping, and configuration visible and usable. The right person is comfortable spending most of their time deep in backend and data problems, while staying sharp enough on the frontend to own a feature end to end without waiting on someone else to build the interface.

What You'll Do

• Build and own backend integrations: Design, implement, and maintain the services, pipelines, and APIs that connect Pivotal's platform to external healthcare systems, billing tools, and partner data sources. Take end-to-end ownership from design through production.

• Build supporting frontend surfaces: Develop the React-based interfaces that let internal teams and customers monitor integration status, configure mappings, and troubleshoot data flow issues. Frontend work here is real but secondary to the backend surface area.

• Work with real-world healthcare data: Build integrations that handle the practical realities of healthcare data like SFTP-based ingestion, evolving file formats, inconsistent schemas, and complex onboarding workflows with pragmatism and care.

• Contribute to architectural decisions: Be an active participant in technical planning and design discussions. Bring your full-stack perspective and push back when you see a better path.

• Operate with autonomy: With a small team and real ownership, there's no room for passengers. You'll identify what needs solving and drive your work forward without heavy oversight.

• Partner closely with product and stakeholders: Work directly with product to understand requirements, clarify scope, and translate integration needs into sound technical plans, on both the data pipeline and the interface that surfaces it. Be comfortable in conversations that involve customers, partners, or domain complexity.

• Write reliable, maintainable code across the stack: Hold a high bar for code quality, testing, and system design. Correctness matters here, these integrations affect real clinical and financial data.

• Surface problems early: Communicate blockers, risks, and open questions proactively. Keeping the team aligned is part of doing the job well.

Who You Are

• 5+ years of software engineering experience, with a strong backend focus and genuine comfort building frontend features when needed

• Solid understanding of backend fundamentals: system design, data modeling, API development, and service reliability

• Comfortable working with database-heavy systems and building around messy, real-world data

• Working experience with React-based frontend development, enough to build and own a feature-level UI without heavy support

• Experience building or maintaining integrations with third-party APIs, data pipelines, or external enterprise systems

• Comfortable in greenfield environments with evolving requirements and ambiguous ownership

• Able to collaborate closely with product, customers, and partners, not just engineering teammates

• Self-directed and proactive: you identify problems and drive them to resolution

• Strong communicator who surfaces ambiguity early and works well across functions

• Experience in early-stage or startup environments where engineers own outcomes, not just tasks

• Python experience preferred on the backend; candidates from other backend languages are welcome if they're prepared to interview in Python and ramp quickly

Extra Credit If You Have

• Experience with healthcare integrations: EDI workflows (835/837), HL7/FHIR, ICD-10/CPT codes, or platforms like Epic or Cerner

• Experience with SFTP-based ingestion, data sharing pipelines, or clinical data access workflows

• Familiarity with TypeScript, React Router, or Remix-style frameworks

• Familiarity with FastAPI or similar Python backend frameworks

• Background in integration-heavy or forward-deployed engineering roles

• Background in FinTech, HealthTech, or other regulated industries handling sensitive data

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.