Claims Operations Manager (m/f/x)

Join to apply for the Claims Operations Manager (m/f/x) role at Progyny, Inc.

1 day ago Be among the first 25 applicants

Who We Are

At Progyny Global, we’re on a mission to make fertility, pregnancy, and family‑forming care accessible worldwide. As part of Progyny Inc., we combine world‑class clinical expertise with groundbreaking technology to deliver inclusive, culturally competent support for families everywhere.

Your Mission

As Claims Operations Manager, you play a key role in supporting and evolving our global claims operations. You will work hands‑on across claims processes, partner coordination, and benefit interpretation, helping ensure claims are processed accurately, efficiently, and in line with benefit design and regulatory requirements.

This role is ideal for someone with insurance‑adjacent experience who enjoys working in complex systems and collaborating across teams to improve processes.

You will work closely with Member Experience, Legal, Product, and Tech, supporting complex cases and contributing to continuous improvement of our claims ecosystem.

Tasks

Claims Operations

• Review, assess, and process claims end‑to‑end, applying benefit rules, documentation requirements, and validation logic
• Monitor quality metrics and operational performance
• Coordinate escalations and complex case resolution in close collaboration with internal stakeholders (e.g. Member Experience, Leadership Team, Legal)
• Identify recurring issues and drive continuous improvement across claims workflows and partner collaboration.
• Apply benefit and policy logic to real‑world claims scenarios
• Partner with Member Experience and subject matter experts to ensure benefit interpretation is consistent, accurate, and member‑friendly
• Support the maintenance of clear documentation for claims logic and operational guidelines

Claims Processes & Product Support

• Contribute to the ongoing development of claims processes and the Wallet product
• Translate benefit rules into clear, scalable operational workflows
• Support process updates as new markets, benefit types, or regulatory requirements are introduced

Requirements

• Strong understanding of regulatory, compliance, and legal considerations, ideally in a global or multi‑market context
• Bachelor’s degree in a relevant field (e.g. business, healthcare, insurance, law, or operations), or equivalent practical experience, plus 5+ years of professional experience in claims operations, insurance, benefits administration, or a related operational role
• Experience collaborating with senior stakeholders across Legal, Product, Tech, and global operations teams
• Highly structured, systems‑oriented mindset with a strong sense of ownership and accountability
• Strong attention to detail, analytical thinking, and clear, professional communication skills

Why Join Us

• Bonus Program & Company Equity : Bonuses and ownership opportunities to share in Progyny’s success.
• Fertility & Family‑Building Benefits : Access to the Progyny Global Platform with a €5,000 annual benefits budget.