---
title: 'Lead, State Arbitration at recoursehealth.com'
canonical: 'https://feeny.ai/job/lead-state-arbitration-recoursehealth-com-san-francisco-hpbhhjqy1jfv'
type: 'job'
last_seen: '2026-09-12'
---

# Lead, State Arbitration at recoursehealth.com

- **Company:** recoursehealth.com
- **Location:** San Francisco, CA
- **Compensation:** $100k–$140k
- **Employment:** full-time
- **Work type:** onsite
- **Posted:** 2026-07-29
- **Last confirmed live:** 2026-09-12
- **Apply:** https://jobs.gem.com/recoursehealth-com/am9icG9zdDpLCbEAMuVLbYSmU9JUef_U

## Job description

Twenty states run their own arbitration programs. Nobody has figured them all out. That's the job.

## Why This Exists

A federal arbitration system called Independent Dispute Resolution, or IDR, now determines billions of dollars in healthcare payments each year. Providers win the vast majority of disputes, yet most eligible claims are never filed. The process is manual, fragmented, and resource-intensive, and most providers don't have the infrastructure to pursue what they're owed.

The No Surprises Act created the federal framework. But a significant share of out-of-network disputes never touch it, because roughly twenty states run their own arbitration programs with their own rules, their own filing windows, their own arbitrator networks, and their own quirks.

Most of the industry ignores this. Claims that should be filed at the state level get pushed into the federal process where they lose on eligibility, or they get written off entirely. That's money on the floor, and it's a market almost nobody has systematically claimed.

## Why This Is Hard (and Interesting)

There is no manual for this. Every state is its own puzzle. The statute says one thing, the agency guidance says another, the actual filing portal behaves a third way, and the only way to know what really happens is to file and find out.

You'll need to read primary sources, talk to state agencies, figure out how a program actually operates, and then turn that into something repeatable that the rest of the team can execute without becoming an expert themselves.

The reward is that this compounds fast. Every state you crack becomes a durable advantage, because the next company has to do the same work from scratch. And unlike federal IDR, where everyone is now competing, most of these programs are wide open.

## Who We Are

Recourse is being built in partnership with 25M Health, a healthtech venture firm. We have institutional backing, a shared platform team spanning engineering, strategy, design, and back-office, and early access to large provider systems.

We are actively filing disputes for real customers, including a large multi-facility health system and a litigation-finance partner with hundreds of millions in claim value. This is a funded, validated opportunity with real customers and real data.

We are a small, nimble team. We move quickly and we value clarity over theater. We want this to be the best work of your career. The stretch you look back on as the one where you shipped real things, with people who raised your game, on something that mattered.

We care about clear thinking, high ownership, intellectual honesty, and direct communication. We believe operations, product, and engineering should operate as one pod, not three functions. We want the machines to do machine work, and the humans to do their best work.

## The Role

You'll own state-level arbitration end to end. You will:

- Decide which states we pursue, in what order, based on volume, rules, and how winnable they are
- Research state statutes, regulations, agency guidance, and arbitration procedures, and figure out what they actually mean operationally
- Build the filing process for each state you take on, from eligibility criteria through submission and follow-through
- Identify claims currently defaulting into the federal process that belong at the state level, and build the routing logic to catch them
- Turn your research into clear instructions and workflows the rest of the team can follow without becoming state-law experts
- Partner with engineering to encode state-specific rules into the platform rather than living in your head
- Own outcomes: filing volume, win rate, and recovery for every state program you stand up

## Who You Are

You are a researcher who ships. You can read a statute, a regulation, and an agency FAQ, reconcile the three, and write down what someone should actually do on Tuesday morning.

You are comfortable with ambiguity. There is no playbook for most of these programs. You'll be building it. That should sound fun rather than frightening.

You are AI-pilled. You've used AI tools to accelerate research and turn dense source material into usable output. You have opinions about which ones are useful and which are hype.

You have a bias to action. You don't wait for certainty. You form a view from the sources, test it with a real filing, and adjust. Most decisions are reversible and do not need extensive study.

You care about the details. In arbitration, a missed procedural requirement loses a case that was otherwise a winner. Precision is the job.

You put the team first. You are reliable and fully invested. You take your vacations. You check on your teammates. You help build a culture where people do their best work because they are supported, not squeezed.

## What You Bring

- 4+ years in a role that rewards regulatory research, compliance analysis, claims operations, or policy work
- Demonstrated ability to read primary legal or regulatory sources and translate them into operational guidance
- Comfort with data and analytical tools. You can size an opportunity yourself before committing to a state
- Hands-on fluency with AI tooling. You have used it to ship or accelerate real work, not just tried the demos
- Clear written communication. Your output is documentation other people rely on
- A preference for small teams and early-stage chaos over mature org charts

Strong plus, not required: healthcare revenue cycle, out-of-network claims, No Surprises Act, state insurance regulation, or arbitration experience. Paralegal, compliance, or health policy backgrounds are welcome. If you have the domain, you'll move faster. If you don't, we'll teach you.

Sound judgment, research depth, and ownership mindset are required. Grit matters more than pedigree.

## Why This Role

You'd be building a business line, not filling a seat. State arbitration is a real and growing part of this market, and right now it's mostly unclaimed. The person who maps it properly creates something durable.

You'll also have unusual latitude. Nobody here knows these programs better than you will after month two, which means the strategy is genuinely yours to set.

If you want this to be the most memorable stretch of your career, where you shipped something real, with a team you respected, in a domain that actually matters, this is the seat. Please apply even if you don't fit 100% of these requirements. We would like to talk.

## Equal Opportunity

Recourse is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, national origin, age, disability, veteran status, or any other characteristic protected by law. We believe the best teams are built from people with different backgrounds and perspectives, and we're committed to creating an environment where everyone can do their best work.

## About recoursehealth.com

## Company Overview
- **One-liner**: Recourse Health provides an AI-powered claims-intelligence platform that automates the end-to-end federal Independent Dispute Resolution (IDR) process for healthcare providers, optimizing disputes for dollars recovered rather than win rate.
- **Entity Type**: Private (Seed stage)
- **Headquarters**: San Francisco, California, USA
- **Founded**: 2026
- **Founders**: David Hegarty (CEO & Founder)

## Core Business
- Primary industry/industries: Healthcare Technology (Healthcare IT), Claims Management, Revenue Cycle Management
- Target customers: Healthcare providers (physician groups, hospitals), particularly those navigating the federal IDR process created by the No Surprises Act (B2B).
- Mission or purpose statement: To run federal IDR for physician groups and optimize every filing for dollars recovered, lowering the filing threshold and maximizing recovery per claim.

## Products & Services
- **Recourse Claims Intelligence Platform**: A SaaS platform that uses AI and large language models (LLMs) to automate the entire IDR workflow. It ingests standard 837/835 claims data, confirms eligibility, maps deadlines, and prioritizes disputes with the highest recovery potential.
- **Claims Intelligence**: An AI-powered module that analyzes claims and remittance data to guide the offer and supporting evidence for each dispute.
- **Submission Intelligence**: An automated module that assembles the evidence package, addresses statutory factors, and files the complete IDR submission on time.
- **Recovery Intelligence**: A dashboard for tracking every active dispute, dollar at stake, and recovery outcome, with the system learning from each result.
- **CMS Filing Benchmark**: A free service that reviews a provider's public CMS filing record and compares their performance against 632 high-volume filers.

## Market Standing
- **Valuation/Market Cap**: Not publicly disclosed.
- **Key Metric**: The company is venture-backed, having raised a **Seed VC** round. Lead investor is **25Madison**.
- **Notable Investors/Partners**: **25Madison** (lead investor).
- **Growth Signals**: A very early-stage startup (founded in 2026) that has already secured venture funding and launched a live product. The company is addressing a specific, high-stakes pain point created by a federal regulation (No Surprises Act), with a clear value proposition tied to recovery dollars. The CEO has a strong background, having previously founded Nutshell Labs and held roles at Credit Karma, Opendoor, and Microsoft.

## Competitive Advantages
- **Outcome-Focused Approach**: The company explicitly differentiates itself from competitors by optimizing for "dollars recovered" rather than the industry-standard metric of "win rate." They claim that across 5.7 million decided claim lines, the highest-win-rate filers recover the least money per dollar offered.
- **End-to-End Automation**: Recourse automates the entire IDR lifecycle, from eligibility finding to submission and tracking, which they claim makes smaller claims economical to pursue.
- **Low-Friction Integration**: The platform works from existing 837 and 835 files that providers already produce, requiring no new system of record.
- **Contingency-Based Pricing**: The company's compensation comes only from the recovery they create, aligning their incentives directly with the client's financial outcomes.
- **AI/LLM Powered Reasoning**: Uses advanced reasoning to strengthen the "ask" and the evidence behind it, providing auditability and compliance.

## Strategic Focus
- **Scaling Engineer & Growth Team**: The company is actively hiring for roles like **Engineer, Claims Platform** and **Growth Analyst, Market Intelligence**, indicating a dual focus on product development and market expansion.
- **Expanding Claim Coverage**: The first lever of their strategy is to lower the filing threshold, allowing providers to pursue a larger pool of eligible claims.
- **Increasing Recovery per Claim**: The second lever is to strengthen the filing strategy to increase the value of each completed dispute.

## Why Work Here
- **Early-Stage Impact**: As a seed-stage startup founded in 2026 with 1-10 employees, new hires will have a massive impact on the product, culture, and direction of the company. You work directly with the founder.
- **High-Stakes Problem**: The work directly addresses a complex, federally-mandated process (the No Surprises Act), helping healthcare providers recover millions in disputed payments. The work is meaningful and quantifiable.
- **Remote-First Culture**: The company operates with a remote workspace, though there is a presence in San Francisco, CA. The careers page lists roles as "In-Office or Remote," suggesting flexibility.
- **Strong Founder**: David Hegarty (CEO & Founder) has a proven track record with experience at Credit Karma, Opendoor, and Microsoft, and is currently the sole executive. Working here means learning directly from a seasoned founder.
- **Technology Stack**: The company is building with AI and LLMs, offering a modern and challenging technical environment.
- **Perks**: Specific perks are not listed, but as a VC-backed startup, standard benefits (equity, health, etc.) are likely.

## Sources
1. [recoursehealth.com](https://www.recoursehealth.com/)
2. [builtin.com](https://builtin.com/company/recourse-health)
3. [cbinsights.com](https://www.cbinsights.com/company/recourse-health)
4. [linkedin.com](https://linkedin.com/company/recoursehealth)
5. [cbinsights.com (People)](https://www.cbinsights.com/company/recourse-health/people)
6. [gem.com (Careers Page)](https://jobs.gem.com/recoursehealth-com)

## Other roles at recoursehealth.com

- [Growth Analyst, Market Intelligence](https://feeny.ai/job/growth-analyst-market-intelligence-recoursehealth-com-san-francisco-jz277amebapb) — San Francisco, CA
- [Growth Lead, Provider Pipeline](https://feeny.ai/job/growth-lead-provider-pipeline-recoursehealth-com-san-francisco-j0j55205305g) — San Francisco, CA
- [Provider Partnerships Lead](https://feeny.ai/job/provider-partnerships-lead-recoursehealth-com-san-francisco-zsf84430pc6s) — San Francisco, CA
- [AI Engineer, Decision Intelligence](https://feeny.ai/job/ai-engineer-decision-intelligence-recoursehealth-com-san-francisco-6665xenhts39) — San Francisco, CA
- [Engineer, Data & Integrations](https://feeny.ai/job/engineer-data-integrations-recoursehealth-com-san-francisco-qfbcxyhjpmcz) — San Francisco, CA
- [Analyst, Payer Strategy](https://feeny.ai/job/analyst-payer-strategy-recoursehealth-com-san-francisco-p0z3wc7b3zyk) — San Francisco, CA
- [Head of Product](https://feeny.ai/job/head-of-product-recoursehealth-com-san-francisco-dc7q6p07aj30) — San Francisco, CA
- [IDR Analyst](https://feeny.ai/job/idr-analyst-recoursehealth-com-san-francisco-4qtnc9hkfwfm) — San Francisco, CA
- [Engineer, Claims Platform](https://feeny.ai/job/engineer-claims-platform-recoursehealth-com-san-francisco-tjmz9sxpfc1w) — San Francisco, CA