Lead, State Arbitration
San Francisco, CA, USA
USD 100k-140k / year
Posted on Jul 31, 2026
Lead, State Arbitration
San Francisco, CA
Operations
In office
Full-time
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.
Compensation
The base pay range for this role is $100,000 – $140,000 per year.
Req ID: R10