General Member Reimbursement Specialist

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.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. 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 Ability to work independently, exercise sound judgment, and escalate issues appropriately Experience partnering cross-functionally (e.g., Finance, Operations, Eligibility) to resolve issues Ability to handle sensitive or complex conversations with professionalism and empathy * 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 careIn 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. Our Growth is Creating Great Opportunities!Progyny is growing and we want to hire the most talented people we can. Continued success depends on it! Once you've had a chance to explore our current open positions, apply to the ones you feel suit you best and keep track of both your progress in the selection process, and new postings that might interest you!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 View email address on click.appcast.io you for your interest in Progyny! #J-18808-Ljbffr Progyny Inc.