PG
Senior Lead Claims Operations (m/f/x)
Contract type
Ongoing
Work mode
Remote · Berlin
Experience
Senior · 5+ years
Job description
A hands-on Senior Lead Claims Operations role leading a small claims team and strengthening global claims operations at Progyny Global. The player-coach position combines team leadership, operational oversight, and product improvement, working with Product and Engineering on claims tools.
At a glance
- Work mode
- Remote · Berlin
- Languages
- English – fluent
What you'll do
- Lead and develop the claims team through coaching, feedback, and regular quality reviews
- Coordinate workloads, priorities, and coverage to meet service levels and maintain a sustainable workload
- Handle complex or escalated cases, review selected claims, and support processing during periods of increased demand
- Define clear targets and SLAs for the team, such as turnaround times, processing accuracy, and member satisfaction; track them continuously, report progress to the VP Member Experience, and drive measurable improvements quarter over quarter
- Use operational data and team insights to identify recurring issues and improve workflows across markets and product lines
- Maintain consistent claims decisions, clear documentation, and effective escalation and quality-assurance processes
- Ensure members receive accurate, timely, and empathetic communication throughout the claims journey
- Drive improvements to the internal claims processing tool, member-facing claims submission experience, and wallet with Product and Engineering, and identify where AI can make claims work faster and more accurate
- Define product requirements and acceptance criteria, including where AI may support a decision and where human review remains mandatory, and help prioritise enhancements based on member needs, operational impact, data protection, and risk
- Coordinate user acceptance testing, validate features before launch, and prepare the team through updated workflows and training
- Monitor results after launch, including the quality and accuracy of AI outputs, and drive further improvements
- Review provider contracts, invoices, and claims documentation for market-specific contractual and regulatory requirements, involving Legal, Clinical Operations, or Finance where needed
- Maintain the claims framework and translate agreed requirements into practical workflows, controls, and guidance
- Partner with Finance on payment accuracy and reconciliation, support audits, and address control or compliance gaps
What we're looking for
- At least 5 years of experience in claims, healthcare benefits, reimbursement, insurance operations, or a related field, including three years coordinating or leading a team
- Hands-on expertise in complex claims, quality assurance, operational controls, and financial reconciliation
- Hands-on experience using AI tools in daily work, ideally in operational workflows such as document processing or case handling, with a clear sense of where human judgement and data protection require oversight
- Experience reviewing contracts, invoices, and claims documentation against market-specific contractual and regulatory requirements, recognising when specialist input is needed
- Experience defining product requirements with Product and Engineering, testing new features, and supporting operational rollouts
- Experience improving processes and managing competing priorities in a fast-paced environment, ideally within a technology company or scale-up
- Strong analytical skills, precision, and attention to detail, using operational KPIs to guide decisions and improvements
- Clear communication, sound judgement, and a collaborative, empathetic leadership style focused on the member experience
- Professional fluency in English
Your team
Claims team
A small claims team led by this role, working closely with the VP Member Experience, Legal, Clinical Operations, and Finance.
Apply
About Progyny Global
Part of the Progyny, Inc. family, Progyny Global combines world-class clinical expertise with innovative technology to deliver inclusive, culturally competent support that helps individuals and families navigate some of life's most important journeys.
Mission
Make fertility, pregnancy, and family-forming care accessible worldwide.
Key facts
- Part of the Progyny, Inc. family
- Expanding access to care and breaking down barriers worldwide