Optimization Analyst, Eligibility Focus

Pivotal Health

. Serve as the go-to contact for Client Success on eligibility questions, handling tickets, calls, and payor outreach .

Posted 10/2/2026full-timeUnited StatesJunior💰 $85,000 - $105,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in healthcare operations and revenue cycle management, with a strong focus on eligibility determination and claims analysis. Proficient in SQL and data visualization tools like Metabase and Power BI to drive insights and improve processes.

Highest-signal resume keywords

Healthcare Operations ExperienceSQL ProficiencyData Visualization in Metabase or Power BIClient Communication SkillsDetail-Oriented Analysis

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

SQLExcel ProficiencyData AnalysisClaims ReviewEligibility Determination

Soft Skills

Customer-Service OrientationClear WritingOrganizational SkillsTeam Collaboration

Tools & Technologies

MetabasePower BIAsanaNotion

Industry Keywords

Revenue CycleManaged CareNo Surprises ActIDR Eligibility RulesHealth Plan Structures

Tech Stack

Tools & technologies

SQL

About the role

Key responsibilities & impact

Serve as the go-to contact for Client Success on eligibility questions, handling tickets, calls, and payor outreach
Act as the first point of intake for payor eligibility inquiries
Pull claims data to identify root causes
Review payor, internal, and IDRE eligibility flags and determine whether claims are truly ineligible, product defaults requiring correction, or payor flags to dispute
Communicate clear eligibility determinations to Client Success
Document recurring default-Ineligible patterns and work with Product on corrective actions
Build Client Success-facing materials explaining IDR eligibility and responses to payor-specific questions
Define handling and escalation processes for disputed eligibility flags, including payor outreach and legal escalation
Build and own eligibility-risk dashboards in Metabase or Power BI
Monitor recurring themes and identify eligibility problems before filings are submitted
Establish the ineligible claims review process and help shift eligibility detection from reactive to proactive

Requirements

What you’ll need

1 to 3 years in healthcare operations, revenue cycle, managed care, consulting, or an analyst role in finance or healthcare
Excel proficiency, including pivot tables
Ability to write basic SQL or use an AI tool to draft and verify SQL
Warm, personable, customer-service-oriented approach
Clear and confident writing
Detail-oriented and organized under volume
Ability to work across teams
Familiarity with the No Surprises Act, IDR eligibility rules, or health plan structures is extra credit
Advanced SQL, data storytelling, or dashboard experience in Metabase, Power BI, or similar is extra credit
Comfort with Asana, Notion, or similar workflow tools is extra credit
Must be authorized to work in the United States without current or future employer sponsorship

Benefits

Comp & perks

Equity
Full health, dental, and vision coverage
Retirement savings plan through 401(k)
Flexible time off
Opportunities for company-wide connection and events
Remote and hybrid flexibility varies by role and team