Healthcare Support Representative

🔥 12 hours ago

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XO Health Inc.

WebsiteLinkedInAll Job Openings

11 - 50 employees

⚕️ Healthcare Insurance

☁️ SaaS

🤝 B2B

Healthcare Insurance • SaaS • B2B

XO Health Inc. is a company that provides comprehensive, tech-enabled health benefit solutions specifically designed for the self-insured market. Their services cater to self-insured employers, brokers and consultants, and third-party administrators, aiming to unify the healthcare experience. XO Health offers a value-based provider network, member advocacy and care navigation, integrated medical and pharmacy plans, and employer stop-loss coverage. Their solutions are focused on balancing cost and quality, providing flexible and tailored healthcare solutions for employers.

📋 Description

• Handle inbound and outbound member and provider inquiries via phone, email, and chat with professionalism and empathy. • Initiative member outreach to provide information and assistance regarding benefits. • Provide accurate information regarding benefits, eligibility, and coverage; claims status and adjudication details; prior authorization requirements and submissions; billing and reimbursement policy questions; and provider portal navigation and support. • Resolve inquiries, complaints, grievances, and escalations promptly while ensuring complete documentation and proper routing when needed. • Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes. • Build trust with members and providers through early, frequent, and personalized engagement. • Process, research, and adjudicate institutional and professional medical claims (including behavioral health), ensuring accuracy, timeliness, and compliance. • Verify eligibility, coverage, and medical necessity under policy guidelines using established systems and workflows. • Investigate and resolve claim denials, appeals, discrepancies, overpayments, and billing errors and payment issues. • Conduct overpayment reviews, coordinate recovery actions, and correct claim financial histories as required. • Support high-cost claim and claimant processes as needed. • Perform provider outreach as necessary to support claims resolution, documentation needs, and payment accuracy. • Collect W-9s and maintain accurate provider information within XO systems to support claims processing, reporting, directory publication, and data transfers. • Collaborate with Business Operations, Network Performance, Product, and Experience teams to resolve complex cases and improve service delivery. • Coordinate with third-party claims vendors to maintain accuracy, compliance, and service excellence. • Identify recurring issues, system gaps, or process inefficiencies and provide feedback to leadership. • Perform quality assurance reviews to ensure claims financial and procedural accuracy. • Document procedures, workflows, and operational guidance as needed. • Meet performance goals in areas such as efficiency and productivity, quality and accuracy, customer satisfaction, compliance, follow-up completion, and attendance. • Maintain confidentiality and compliance with HIPAA, ERISA, and XO Health policies.

🎯 Requirements

• 3–5 years of experience in a healthcare payer, TPA, or health insurance environment, with a blend of contact center/member-provider support and/or medical claims processing/adjudication/claims operations. • Strong knowledge of health insurance concepts, benefits and eligibility, medical terminology, and claims lifecycle management. • Strong English language verbal and written communication skills, with an empathetic, solution-oriented approach. • High attention to detail, sound judgment, and strong analytical problem-solving skills. • Ability to multitask in a fast-paced, digital-first environment while maintaining accuracy and professionalism. • Proficiency in Microsoft Office Suite and customer service and/or claims processing systems.