Director, Carrier Revenue Operations

Thank you for considering Progyny!

We are looking for a Director of Carrier Revenue Operations to join our Finance team. You will be responsible for overseeing and managing relationships with health insurance carriers, ensuring the effective delivery of health insurance products and services. This role involves managing team performance, carrier performance, and developing strategies to optimize carrier partnerships. The ideal candidate will have a deep understanding of the health insurance landscape, an excellent communicator and strong leadership skills.

What you'll do...

• You will be responsible for overseeing Carrier Revenue Operations team and aspects of revenue claims management including the management and development of the team

• Negotiate agreements with carriers, securing favorable terms and conditions

• Monitor and evaluate carrier performance through metrics and reports, addressing any issues or opportunities for improvement

• Collaborate with Implementation to ensure seamless integration and delivery of health insurance products and services

• Analyze market trends and industry developments to identify potential carrier partnerships and enhance service offerings

• Ensure compliance with regulatory requirements and company policies related to health insurance and carrier operations

• Manage the implementation of new insurance products and services, coordinating with carriers to ensure smooth execution

• Lead, mentor, and develop a team of carrier management professionals, fostering a culture of collaboration and excellence

• Prepare and present reports on carrier performance, team performance, and other key metrics to senior management

• Address and resolve any escalated issues or disputes with carriers in a timely and effective manner

• Identify trends in claims denials, reimbursements and payment discrepancies and implement solutions to facilitate successful claims processing

• Analyze large sets of data to identify trends, patterns, and insights. Utilize statistical methods and software tools to support data-driven decision-making

• Lead executive reporting on claims processing, denials, cash flow, and various special projects

• Anticipate & identify risks, drive the development and monitor the implementation of comprehensive mitigation strategies; coordinate financial operations responses to regulatory/client external audit requests

About you...

• 10+ years of experience in health care claims processing/accounting/finance operations

• Bachelor’s degree required

• Extensive experience in health insurance or carrier management roles, with a significant portion in a leadership capacity

• In-depth knowledge of the health insurance industry, including regulatory requirements, carrier operations, and market trends

• Experience managing a large team

• Ability to tap into a wealth of knowledge and experience to solve problems and act as an internal consultant

• Ability to effectively synthesize problems and implement solutions in a fast-paced environment

• Strong experience in excel and comfortable working with large data sets to analyze and reconcile data

• Excellent communication ability, able to partner with internal stakeholders, including senior leadership

• Ability to present findings to executive leadership in a clear and concise manner

Please note: Progyny is unable to provide visa sponsorship for this position. Candidates must be authorized to work in United States without the need for sponsorship, now or in the future.  

About Progyny:   

Progyny is a transformative fertility, family building and women’s health benefits solution, trusted by the nation’s leading employers, health plans and benefits purchasers. We envision a world where everyone can realize dreams of family and ideal health. Our outcomes prove that comprehensive, inclusive and intentionally designed solutions simultaneously benefit employers, patients and physicians. 

Our benefits solution empowers patients with concierge support, coaching, education, and digital tools; provides access to a premier network of fertility and women's health specialists who use the latest science and technologies; drives optimal clinical outcomes; and reduces healthcare costs.  

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