Claims Analyst

Thank you for considering Progyny!

The Claims Analyst is responsible for researching analyzing and resolving complex claim-related inquiries from internal teams and external partners including providers and ancillary laboratories. This role manages claim adjustments reprocessing requests denial investigations and claim status inquiries to ensure accurate and timely resolution.

This position supports efficient claims operations by ensuring accuracy in data review identifying root causes of claim issues and collaborating cross-functionally to resolve escalated concerns. The ideal candidate demonstrates strong attention to detail the ability to manage multiple priorities and a proactive customer-focused approach in a fast-paced environment.

What youll do...

• Maintain expertise in processing requirements benefit structures and reimbursement guidelines across assigned health plans.

• Manage and resolve accounts receivable (AR) for assigned providers and ancillary labs by reviewing and addressing items on open AR reports.

• Lead regular calls with providers and partners to address claim inquiries including claim status denial reasons reprocessing requests and authorization issues.

• Review and follow up on unadjudicated claims proactively contacting providers to obtain missing information or resolve processing barriers.

• Monitor and respond to inquiries through the dedicated claims email inbox ensuring timely investigation and resolution.

• Maintain accurate provider and reimbursement of information in internal systems ensuring data integrity and compliance with plan requirements.

• Act as a liaison between Provider Services Member Services and internal teams for escalated claim issues and complex provider inquiries.

• Review and validate our claims processors weekly reports to ensure claims are adjudicated according to guidelines and plan requirements.

• Collaborate with Provider Account Managers Provider Relations Progyny Care Advocates and the Contracting Team to resolve escalated claims issues and enhance the provider experience.

• Provide ongoing case management for assigned providers and ancillary labs tracking and resolving outstanding claim issues.

• Identify recurring claim processing issues and partner with internal teams to recommend process improvements preventing future delays or denials.

About you...

• 35 years of experience in healthcare claims provider billing or revenue cycle operations including researching claim status resolving denials and managing adjustments or reprocessing.

• Experience in a healthcare environment required; fertility industry experience strongly preferred.

• Knowledge of insurance carriers reimbursement processes medical billing practices and CPT/HCPCS/ICD-10 codes.

• Proficient in Microsoft Excel Outlook and case management or CRM platforms (Salesforce preferred).

• Ability to manage multiple priorities navigate varying insurance products and benefit structures and work in a fast-paced data-driven environment.

• Excellent communication and interpersonal skills including managing complex provider conversations professionally.

• Strong organizational analytical and problem-solving skills with a focus on accuracy and quality.

• Adaptable proactive and able to work independently while collaborating cross-functionally and escalating issues appropriately.

Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship now or in the future.

About Progyny:

Progyny (Nasdaq: PGNY) is a global leader in womens health and family building solutions trusted by the nations leading employers health plans and benefit purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive inclusive and intentionally designed solutions simultaneously benefit employers patients and physicians.

Our benefits solution empowers patients with concierge support coaching education and digital tools;provides access to a premier network of fertility and womens health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.

Our mission is toempower healthier supported journeys through transformative fertility family building and womens health benefits.

Headquartered in New York City Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company CNBC Disruptor 50 Modern Healthcares Best Places to Work in Healthcare Forbes Best Employers Financial Times Fastest Growing Companies Inc. 5000 Inc. Power Partners and Crains Fast 50 for NYC. For more information visit .

Our perks:

• Family friendly benefits: Paid family and parental leave preconception fertility and family building benefits (including egg freezing IVF and adoption support) family and pet care fund and Parents Employee Affiliation Group

• Menopause and midlife care

• Health dental vision and life insurance options for employees and family

• Free in-person virtual and text-based mental health and wellness support

• Paid time off including vacation sick leave personal days and summer flex time

• Company equity

• Bonus program

• 401(k) plan with company match

• Access to on-demand legal and financial advice

• Learning and development programs to help you grow professionally and a mentorship program

• Company social eventsto include annual volunteer day and donation matching

• Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

In compliance with New York Citys Wage Transparency Law the hourly salary wage range for NYC-based applicants is: $28.85/hour - $31.25/hour. There are a variety of factors that go into determining a salary range including but not limited to external market benchmark data geographic location and years of experience sought/required. Progyny offers a total compensation package comprised of base salary cash bonus and equity.

Progyny is proud to be anEqual Opportunity and Affirmative Action respect and seek to empower each individual and support the diverse cultures perspectivesskillsand experiences within our workforce. All qualified applicants will receive consideration for employment without regard to race creed color religion sex sexual orientation gender identity or expression national origin disability age genetic information marital status pregnancy or related condition status as a protected veteran criminal history consistent with legal requirements or any other basis protected by law.

If you are an individual with a disability and need assistance or an accommodation during the recruiting process please send an e-mail to .

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