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

Remote · Switzerland Full-time

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

  • Pivotal Health (formerly Radix Health) helps healthcare providers and health systems achieve fair reimbursement through Independent Dispute Resolution under the No Surprises Act. It was founded in 2023, and is headquartered in , with a workforce of 51-200 employees. Its website is http://www.pivotalhealth.ai.
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