Senior Lead Claims Operations (m/f/x)

Progyny; Berlin; On-site; EUR 110,000 - 140,000; Full time

Job summary

Progyny Global in Berlin seeks a hands-on Senior Lead Claims Operations to lead our small claims team, strengthen global claims operations, and drive the tools that support members and the team.

This player‑coach role blends team leadership, operational oversight, and product improvement. You will manage workload, handle complex cases, and collaborate with Product and Engineering to enhance our claims platform and AI‑assisted workflows.

Qualifications

• 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.

Responsibilities

• Lead and develop our 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, track progress to the VP, and drive improvements.
• Use operational data to identify recurring issues and improve workflows across markets and product lines.
• Maintain consistent claims decisions, documentation, and QA processes.
• Ensure members receive accurate, timely, and empathetic communication throughout the claims journey.
• Drive improvements to our internal claims processing tool, member-facing submission experience, and wallet with Product and Engineering; identify AI opportunities.
• Define product requirements and acceptance criteria, including AI where appropriate; prioritize enhancements based on needs and risk.
• Coordinate user acceptance testing, validate features before launch, and train the team on new workflows.
• Monitor results after launch, including AI output quality, and drive improvements.
• Review provider contracts, invoices, and claims for market-specific requirements; involve Legal/Finance as needed.
• Maintain the claims framework and translate requirements into workflows, controls, and guidance.
• Partner with Finance on payment accuracy, support audits, and address gaps.

Skills

Team leadership

Claims operations

AI in operations

Quality assurance

Analytical skills

English fluency

Job description

Who We Are

At Progyny Global, part of the Progyny, Inc. family, we're on a mission to make fertility, pregnancy, and family-forming care accessible worldwide.

By combining world-class clinical expertise with innovative technology, we deliver inclusive, culturally competent support that helps individuals and families navigate some of life's most important journeys.

With Progyny's support and global reach, we're expanding access to care and breaking down barriers so that more people can build the families they want, wherever they are in the world.

Role Overview

We’re looking for a hands‑on Senior Lead Claims Operations to lead our small claims team, strengthen our global claims operations, and drive the development of the tools that support our members and team.

Our members come to us during one of the hardest phases of their lives. A fertility journey is physically and emotionally exhausting, and a slow reimbursement or an unclear answer adds stress nobody should have to carry. That is why member experience sits at the heart of every claims process we run: we respond fast, we explain decisions clearly, and we treat every piece of member feedback as important. We want our members to feel the difference to a traditional insurer at every step.

This is a player‑coach role combining team leadership, operational oversight, and product improvement. You’ll guide and develop the team, manage quality and workload, and continuously improve our processes. You’ll also stay close to daily operations by handling complex or escalated cases, reviewing selected claims, and stepping in during periods of increased demand. Your routine caseload will be significantly smaller than that of a Claims Processor, allowing you to focus where your experience and judgement have the greatest impact.

Working closely with the VP Member Experience, Legal, Clinical Operations, and Finance, you’ll help maintain a fair, consistent, and compliant claims framework across our markets. You’ll bring practical judgement to reviewing contracts, invoices, and claims documentation, recognising country‑specific requirements and knowing when specialist input is needed.

You’ll also drive the continuous development of our internal claims processing tool, member‑facing claims submission experience, and wallet in partnership with Product and Engineering. You’ll translate operational and member needs into clear requirements, help prioritise improvements, and ensure new features meet those requirements before launch.

We’re looking for a collaborative, pragmatic leader who combines strong analytical skills with precision and attention to detail. You’ll enjoy being close to the work, use data to guide decisions, take ownership of improvements, and understand the impact every claim can have on a member’s journey.

What you will do

Team leadership and daily operations

• Lead and develop our 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 on progress to the VP Member Experience, and drive measurable improvements quarter over quarter.

Process improvement and member experience

• 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.

Claims products, wallet, automation and AI

• Drive improvements to our 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.

Claims framework, regulatory requirements, and controls

• 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.

Requirements

• 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 your 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.