Claims Analyst

Progyny, Inc.•New York, NY

1d•$29 - $31

About The Position

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.

Requirements

3–5+ 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.

Responsibilities

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 processor’s 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.

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