General Member Reimbursement Specialist
Progyny
This listing was originally posted on Progyny's careers page. Formulate is an equal opportunity job aggregator and is not involved in the hiring process. Where salary information is estimated, it is derived from BLS industry benchmarks and may differ from actual compensation.
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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.
What you’ll do…
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.
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, 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.
About Progyny:
Progyny (Nasdaq: PGNY) is a global leader in women’s health and family building solutions, trusted by the nation’s 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 women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.
Our mission is to empower healthier, supported journeys through transformative fertility, family building and women’s 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 Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.
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 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
In compliance with New York City's 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 an Equal Opportunity and Affirmative Action employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and 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 apply@progyny.com.
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