Claims Analyst

Job description

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. What you’ll do... 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 i...