Can confirm, it’s permissions related. After manually allowing Input Capture and Full Disk Access in System Preferences, I hit start and let it sit for a couple hours - it eventually ran!
For the commandline/terminal-savvy amongst us, I’m sure there’s a chmod command that could be run at the root directory wherever PoE II installs... PoE II started up before I explored that route, but would love input in that direction.
Note on graphics: frame rate is quite laggy on the default settings. Running mine on low seemed to fix.