General Member Reimbursement Specialist

The 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 elevate 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. NOTE: Candidates must be based in the United States; Progyny does not provide visa sponsorship. Equal Opportunity Employer Progyny is an Equal Opportunity and Affidavit Action employer. 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. #J-18808-Ljbffr Progyny, Inc