Lead Software Engineer (Backend)
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.
About the Role
We’re hiring a Lead Software Engineer to help us build the backend systems and APIs that power our core platform. You’ll work closely with our product, data, and frontend teams to create scalable, reliable services that enable fast, accurate out-of-network reimbursement for providers. This is a high-impact role where your work will directly shape the backend architecture of a growing, fast-moving healthcare startup.
If you enjoy designing systems that solve complex problems and seeing the tangible impact of your work in real time, this is the role for you.
What You’ll Do
Build and maintain backend systems: Design and implement scalable backend services that support high-throughput data workflows and real-time decision-making.
Develop robust APIs: Build secure, performant, and reliable APIs that power our platform and integrate with internal and external systems.
Collaborate across teams: Work with Product, to ship features end-to-end. Translate ambiguous requirements into technical solutions that have real business impact.
Shape our architecture: Contribute to decisions around system design, performance, and scalability. Help define patterns and best practices for a growing engineering team.
Own the full development lifecycle: From design and implementation to testing, deployment, and post-release support — you’ll see your work through from start to finish.
Improve developer experience: Advocate for code quality, testing, DevOps, and observability, making it easier for the team to ship reliably.
Mentor and grow the team: Share knowledge, conduct code reviews, and help junior engineers grow technically and professionally.
Who You Are
Bachelor’s degree in STEM preferred (additional experience in lieu of a degree is also accepted)
7+ years of software engineering experience, ideally building service-oriented or distributed systems.
Proven experience designing, scaling, and maintaining backend systems in production.
Deep understanding of software engineering fundamentals and design patterns.
Strong SQL skills and experience with relational databases (PostgreSQL preferred).
Proficient in Python (FastAPI/SQLAlchemy) or another object-oriented language.
Experience with cloud infrastructure (GCP or AWS preferred).
Familiarity with DevOps, infrastructure-as-code, and CI/CD pipelines is a plus.
Pragmatic problem-solver: you know how to balance ideal architecture with real-world constraints.
Comfortable in fast-paced, early-stage environments where your work has direct impact.
Extra Credit If You Have
Previous experience in FinTech, HealthTech or highly regulated industries.
Why You’ll Love Working Here
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.
Employment Information
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.