General Member Reimbursement Specialist

Progyny, Inc.•New York, NY

2d•Hybrid

About The Position

Thank you for considering Progyny! The General Member Reimbursement (GMR) Specialist is responsible for managing and resolving member reimbursement and financial assistance cases with accuracy, efficiency, and a high level of member service. This role supports members throughout the reimbursement lifecycle by reviewing eligibility, processing payments, maintaining benefit information, and communicating case outcomes in a timely and empathetic manner. The GMR Specialist plays a critical role in ensuring operational excellence by meeting service-level expectations, maintaining data 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.

Requirements

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, financial assistance programs, or reimbursement workflows
Working knowledge of CPT, HCPCS, and ICD-10 codes, and general medical terminology
Strong proficiency in 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.

Responsibilities

Manage member reimbursement, claims billing, and financial assistance cases, ensuring accurate processing and timely resolution.
Review documentation, validate eligibility, resolve discrepancies, and support end-to-end reimbursement and payment workflows.
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.
Support reimbursement workflows related to fertility, women’s 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 and maintaining accuracy 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.

Benefits

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 events to 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