[Remote] Senior Applied AI/ML Engineer, Claims Decisioning & Optimization

Note: The job is a remote job and is open to candidates in USA. Pivotal Health is the leading technology platform that helps healthcare providers get paid fairly in an increasingly complex reimbursement landscape. As a Senior Applied AI/ML Engineer, you will design, build, and improve production AI systems that generate optimal offers for insurance claims, working at the intersection of machine learning and software engineering to solve complex decision-making problems at scale.

Responsibilities

• Own and improve production AI systems. Design, deploy, and optimize AI/ML solutions that influence critical claims and negotiation workflows
• Build offer optimization models. Develop and improve models that generate optimal, fair, and explainable offers while balancing business objectives, customer outcomes, and operational constraints
• Develop AI-powered decisioning systems. Build and refine production workflows involving generation, retrieval, evaluation, orchestration, and automated decision-making
• Improve core product capabilities. Work on systems including position statement generation, offer engine enhancements, open negotiation agents, and configurable decisioning frameworks
• Design evaluation and experimentation frameworks. Create robust testing methodologies and experiments that improve model quality, workflow performance, and business outcomes
• Translate business problems into scalable systems. Partner with product, operations, and engineering teams to define success metrics and convert complex requirements into production-ready solutions
• Optimize model and workflow behavior. Improve prompts, retrieval strategies, model performance, and decisioning logic through continuous experimentation and feedback loops
• Drive engineering excellence. Contribute to architecture, observability, testing, rollout safety, and operational reliability across AI-powered systems
• Accelerate AI adoption across the organization. Leverage AI tools and best practices to improve team productivity and establish scalable AI-native ways of working
• Balance speed with rigor. Deliver impactful systems quickly while maintaining high standards for reliability, fairness, and maintainability

Skills

• 5–8+ years of experience building software systems in production environments, with a strong track record of owning and delivering complex technical solutions
• Experience building and operating applied AI, machine learning, LLM, agentic, or decisioning systems in production
• Experience designing and interpreting experiments, evaluation frameworks, optimization loops, or performance measurement systems
• Strong software engineering background with Python and backend systems supporting production-scale AI applications
• Proven ability to translate complex operational requirements and real-world data into reliable, shipped products
• Experience working in domains where optimization, pricing, matching, decisioning, or marketplace dynamics are central to the business
• Product-oriented mindset with a demonstrated ability to navigate ambiguity, drive initiatives from concept through deployment, and deliver measurable business impact
• Strong communication and collaboration skills, with the ability to partner effectively across engineering, product, and operational teams
• Proven success building optimization systems for pricing, bidding, negotiation, allocation, or equitable decision-making
• Understanding of marketplace dynamics and optimization-driven businesses such as ad tech, lending, credit decisioning, or revenue management
• Familiarity with explainable AI techniques and systems where fairness, transparency, and defensibility are critical considerations
• Knowledge of reinforcement learning, causal inference, mathematical optimization, or advanced experimentation methodologies
• Experience developing AI-powered negotiation, recommendation, or decision-support systems at scale

Benefits

• Offers Equity
• 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

Company Overview