Claims Analyst

Member Services New York, New York


Description

The Claims Analyst is responsible for investigating and resolving claim related inquiries and other types of requests including, but not limited to, claim reprocessing, and inquiries from internal and external sources. The successful candidate will be able to ensure an elevated level of customer service, maintain positive relationships within the network and maximize productivity by reviewing accuracy for data processing. Additionally, they must be able to operate in a fast-paced environment, manage difficult conversations, be thoughtful, resourceful, collaborative, and customer focused.

What you’ll do… 

  • Maintain thorough knowledge of the processing requirements for each plan
  • Review, maintain and manage assigned Providers/Ancillary Labs on the open accounts receivable report and any other relevant reporting
  • Schedule and conduct weekly/biweekly calls for all inquiries including Claim Status, Denial Reasons, Reprocessing and authorization issues
  • Identify and contact providers listed on the un-adjudicated claims report weekly
  • Provide accurate and timely maintenance of the most complex provider and reimbursement information
  • Serve as a liaison for internal stakeholders related to escalated claims issues 

About you…    

  • Prior experience required in a health care environment—knowledge of the fertility industry is a plus
  • Billing experience – knowledge of carriers is a plus
  • Prior experience using Microsoft excel and outlook, and Salesforce knowledge preferred
  • Ability to manage multiple priorities including understanding various insurance products and levels of benefit within each product.
  • Comfortable in an environment with data-driven goals with monthly performance feedback
  • Flexible and able to navigate change
  • Ability to manage difficult conversations
  • Knowledge of CPT, HCPCS, AND ICD-10 codes and understanding of medical terminology strongly preferred
  • Ability to work independently and demonstrate good judgment
  • Excellent interpersonal skills - ability to communicate accurately and effectively with internal and external stakeholders
  • Highly organized, quick learner, with ability to multitask and prioritize work effectively

About Progyny:   

Progyny is a leading fertility benefits management company in the US. We are redefining fertility and family building benefits, proving that a comprehensive and inclusive fertility solution can simultaneously benefit employers, patients, and physicians. Our benefits solution empowers patients with education and guidance from a dedicated Patient Care Advocate (PCA), provides access to a premier network of fertility specialists using the latest science and technologies, reduces healthcare costs for the nation’s leading employers, and drives optimal clinical outcomes. We envision a world where anyone who wants to have a child can do so.  

Our mission is to make any member’s dream of parenthood come true through a healthy, timely, and supported fertility and family building journey.   

Come join a company that’s been recognized by Modern Healthcare as one of the Best Places to Work in Healthcare.  

Our perks:  

  • Family friendly benefits: Paid maternity and paternity, fertility benefits (including egg freezing and IVF), emergency childcare program, parent’s group  
  • Health, dental, vision and life insurance options for employees and family  
  • Paid vacation and summer flex time  
  • Company equity  
  • Bonus program  
  • 401K Match  
  • Company social events  
  • Sit/ stand desks   
  • Flex days (3 days a week in the office) for positions located at NY office 

Progyny is an Equal Opportunity Employer. We respect and seek to empower each individual and support the diverse cultures, perspectives, skills and experiences within our workforce.