Senior Lead Claims Operations

Progyny, Inc.

. Lead and develop the claims team through coaching, feedback, and regular quality reviews .

Posted 11/9/2026contractBerlin • GermanySenior💰 €80,000 - €85,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims management, operational controls, and quality assurance while effectively leading teams to enhance member experience and drive measurable improvements. Proficient in utilizing AI tools to optimize claims processing and ensuring compliance with regulatory requirements.

Highest-signal resume keywords

Claims ManagementTeam LeadershipQuality AssuranceAI Tools UtilizationRegulatory Compliance

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingOperational ControlsFinancial ReconciliationProduct Requirements DefinitionUser Acceptance TestingPerformance TrackingData AnalysisKPI UtilizationWorkflow ImprovementContract Review

Soft Skills

Clear CommunicationEmpathetic LeadershipSound JudgementCollaborationAttention to Detail

Industry Keywords

Healthcare BenefitsInsurance OperationsReimbursementClaims DocumentationMarket-Specific RequirementsMember ExperienceOperational WorkflowsEscalated CasesService LevelsQuality Assurance Processes

About the role

Key responsibilities & impact

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 turnaround times, processing accuracy, and member satisfaction
Track performance, 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, effective escalation, and quality-assurance processes
Ensure accurate, timely, and empathetic communication throughout the claims journey
Drive improvements to internal claims processing tools, member-facing claims submission experience, and wallet with Product and Engineering
Identify appropriate uses of AI to make claims work faster and more accurate
Define product requirements and acceptance criteria, including human-review requirements for AI-supported decisions
Coordinate user acceptance testing, validate features before launch, and prepare the team through updated workflows and training
Monitor post-launch results, including AI output quality and accuracy, and drive further improvements
Review provider contracts, invoices, and claims documentation for market-specific contractual and regulatory requirements
Maintain the claims framework and translate requirements into workflows, controls, and guidance
Partner with Finance on payment accuracy and reconciliation, support audits, and address control or compliance gaps

Requirements

What you’ll need

At least 5 years of experience in claims, healthcare benefits, reimbursement, insurance operations, or a related field
At least 3 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
Understanding of where human judgement and data protection require oversight
Experience reviewing contracts, invoices, and claims documentation against market-specific contractual and regulatory requirements
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
Strong analytical skills, precision, and attention to detail
Experience 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

Benefits

Comp & perks

24-month contract
6-month probation period
40 hours/week
30 days of annual leave