Senior Vice President of Eligibility, Claims and Revenue Management

Thank you for considering Progyny!

We are seeking a strategic and operationally strong Senior Vice President of Eligibility, Claims and Revenue Management to lead and optimize our eligibility and claims functions as well as revenue cycle management. This executive role is critical to ensuring the accuracy, efficiency, and scalability of our core operational processes that directly impact revenue recognition, customer satisfaction, and compliance.

The ideal candidate will bring deep healthcare operations experience, strong technical acumen, and a collaborative leadership style to drive continuous improvement across eligibility data management and outsourced claims processing. This role reports directly to the Chief Operating Officer (COO) and is responsible for leading a team across claims management, eligibility, carrier and member revenue operations, billing, and cash conversion functions. The ideal candidate is a strategic thinker and hands-on leader with a proven ability to drive operational excellence, optimize performance, and foster a high-performing team culture.

What you'll do...

• Lead, mentor, and develop a team of 40+ individuals across multiple functions.

• Establish clear goals, accountability structures, and professional development pathways.

• Promote a culture of collaboration, ownership, and continuous improvement.

• Lead the end-to-end eligibility function, including data validation, exception resolution, and reporting.

• Ensure accurate onboarding and billing of customers, carriers, and members through robust eligibility processes.

• Partner with Client Success and Implementation teams to ensure receipt and integration of standard eligibility file formats.

• Manage exceptions where custom file formats are required, with a long-term strategy to migrate to standard formats.

• Develop and maintain dashboards and KPIs to monitor eligibility data quality and operational performance.

Claims Management:

• Provide strategic oversight of outsourced claims processing partners.

• Map and document current claims workflows and identify opportunities for automation and process optimization.

• Establish and enforce best practices in claims adjudication, auditing, and reporting.

• Collaborate with Finance and Compliance to ensure claims processes align with regulatory and revenue recognition requirements.

Revenue Cycle Management

• Oversee all carrier revenue operations including claims processing and billing options.

• Manage member revenue operations including claims, reimbursement activities, and payment workflows.

• Ensure compliance with payer contracts, regulatory requirements, and internal policies.

• Drive system enhancements and process automation to support scalable operations.

• Define and monitor KPIs across all revenue cycle functions.

• Identify and implement optimization strategies to improve efficiency, accuracy, and financial outcomes.

• Ensure timely and accurate cash conversion across all billing activities.

Cross-Functional Leadership:

• Serve as a key liaison between Operations, Technology, Client Success, Implementation, and Finance teams.

• Drive cross-functional initiatives that improve data integrity, operational efficiency, and customer experience.

• Lead and mentor a high-performing team, fostering a culture of accountability, innovation, and continuous improvement.

About you...

• Bachelor's degree in Business, Finance, Healthcare Administration, or related field (Master's preferred).

• 15+ years of experience in revenue cycle management, with at least 5 years in a senior leadership role.

• Demonstrated success in managing and developing large teams (20+ individuals).

• Strong understanding of healthcare claims processing, reimbursement methodologies, and payer relations.

• Proven track record of driving operational excellence and process optimization.

• Exceptional analytical, communication, and leadership skills.

• Proficiency with revenue cycle technologies and platforms.

• Experience in fertility benefits or specialized healthcare services.

• Lean Six Sigma or similar process improvement certification.

• Familiarity with value-based care or alternative payment models.

• Strong interpersonal skills, ability to work independently and collaboratively within a team environment.

• Ability to effectively manage evolving priorities, multiple projects, and deadlines in a fast-paced environment.

Please note: This is not a digital nomad or remote international position; candidates must be based in the United States. 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 (Nasdaq: PGNY) is a global leader in women's health and family building solutions, trusted by the nation's leading employers, health plans and benefit 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.

Our mission is toempower healthier, supported journeys through transformative fertility, family building and women's health benefits.

Headquartered in New York City, Progyny has been recognized for its leadership and growth as a TIME100 Most Influential Company, CNBC Disruptor 50, Modern Healthcare's Best Places to Work in Healthcare, Forbes' Best Employers, Financial Times Fastest Growing Companies, Inc. 5000, Inc. Power Partners, and Crain's Fast 50 for NYC. For more information, visit www.progyny.com.

Our perks:

• 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 care

• Health, dental, vision and life insurance options for employees and family

• Free in-person, virtual and text-based mental health and wellness support

• Paid time off, including vacation, sick leave, personal days and summer flex time

• Company equity

• Bonus program

• 401(k) plan with company match

• Access to on-demand legal and financial advice

• Learning and development programs to help you grow professionally and a mentorship program

• Company social eventsto include annual volunteer day and donation matching

• Flex days (3 days a week in the office) and onsite meals and snacks for employees reporting into our NY office

In compliance with New York City's Wage Transparency Law, the annual salary [wage] range for NYC-based applicants is: $280,000 - $300,000. 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.

Progyny is proud to be anEqual Opportunity and Affirmative Action employer.We respect and seek to empower each individual and support the diverse cultures, perspectives,skillsand 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 apply@progyny.com.

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