General Member Reimbursement Specialist

New York City, NY - USA

Monthly Salary: Not Disclosed

Posted on: Yesterday

Vacancies: 1 Vacancy

Job Summary

Thank you for considering Progyny!

The General Member Reimbursement (GMR) Specialistis responsible formanaging and resolving member reimbursement and financialassistancecases with accuracy efficiency anda high levelof member service. This role supports members throughout the reimbursement lifecycle by reviewing eligibility processing paymentsmaintainingbenefit information and communicating case outcomes ina timelyand empathetic manner.

The GMR Specialist plays a critical role in ensuring operational excellence by meeting service-level expectationsmaintainingdata integrity across systems and partnering cross-functionally with Finance Eligibility and Member Services teams. The ideal candidate is highly detail-oriented comfortable managing high-volume casework and thrives in a fast-paced data-driven healthcare environment while delivering a positive and supportive member experience.

Whatyoulldo

Manage member reimbursement claims billing and financialassistancecases ensuringaccurateprocessing andtimelyresolution.

Review documentationvalidateeligibility resolve discrepancies and support end-to-end reimbursement andpaymentworkflows.

Work with insurance carriers and health plans to interpret benefits reimbursement methodologies EOBs and member responsibility.

Apply knowledge of medical billing and coding concepts (CPT HCPCS ICD-10) to support reimbursement decisions.

Supportreimbursementworkflows related to fertility womens health or reproductive healthcare services as applicable.

Track and document case activity using Microsoft Excel Outlook and Salesforce or other CRM/case management systems.

Manage a high volume of cases while meeting SLAs andmaintainingaccuracy in a fast-paced data-driven environment.

Communicate clearly and professionally with members and internal partners including handling sensitive or complex conversations with empathy.

Maintain strong attention to detail and data integrity across systems and processes.

Adapt to changing priorities and processes while working independently and collaborating cross-functionally.

About you

2 years of experience in healthcare operations reimbursement billing or claims processing

Experience reviewing insurance eligibility benefits and/or reimbursement guidelines

Familiarity with carrier billing financialassistanceprograms or reimbursement workflows

Working knowledge of CPT HCPCS and ICD-10 codes and general medical terminology

Strongproficiencyin Excel (e.g. filtering data validation) and Outlook; experience with Salesforce or similar case management systems preferred

Proven ability to manage high-volume casework with SLAs and quality expectations

Highly organized with the ability to prioritize and manage multiple workflows simultaneously

Clear and professional written communication skills with experience supporting members or customers

Comfortable working in a metrics-driven environment with regular performance feedback

Ability to work independently exercise sound judgment and escalate issues appropriately

Adaptable and comfortable navigating change in a fast-paced environment

Experience partnering cross-functionally (e.g. Finance Operations Eligibility) to resolve issues

Ability to handle sensitive or complex conversations with professionalism and empathy

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 .

#LI-BR1

Required Experience:

Thank you for considering Progyny!The General Member Reimbursement (GMR) Specialistis responsible formanaging and resolving member reimbursement and financialassistancecases with accuracy efficiency anda high levelof member service. This role supports members throughout the reimbursement lifecycle b...