Claims Analyst

🕒 July 20

🌐 India, United States – Remote

🇮🇳 India – Remote 🇺🇸 United States – Remote

💵 ₹500k - ₹1.5M / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 25%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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XO Health Inc.

WebsiteLinkedInAll Job Openings

11 - 50 employees

🏥 Healthcare

🛡️ Insurance

⚕️ Healthcare Insurance

Healthcare • Insurance • Healthcare Insurance

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. • Initiate member outreach regarding benefits. • Provide information about benefits, eligibility, coverage, claims status and adjudication, prior authorization, billing, reimbursement policies, and provider portal support. • Resolve inquiries, complaints, grievances, and escalations; document and route cases as needed. • Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes. • Build trust with members and providers through personalized engagement. • Process, research, and adjudicate institutional and professional medical claims, including behavioral health claims. • Verify eligibility, coverage, and medical necessity using policy guidelines and established systems. • Investigate and resolve denials, appeals, discrepancies, overpayments, billing errors, and payment issues. • Conduct overpayment reviews, coordinate recovery actions, and correct claim financial histories. • Support high-cost claim and claimant processes. • Perform provider outreach for claims resolution, documentation, and payment accuracy. • Collect W-9s and maintain provider information for claims processing, reporting, directory publication, and data transfers. • Collaborate with Business Operations, Network Performance, Product, and Experience teams. • Coordinate with third-party claims vendors. • Identify recurring issues, system gaps, and process inefficiencies; provide leadership feedback. • Perform quality assurance reviews and document procedures, workflows, and operational guidance. • Meet efficiency, productivity, quality, accuracy, customer satisfaction, compliance, follow-up, and attendance goals. • 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. • Associate or bachelor’s degree in healthcare administration, business, or a related field (preferred). • Experience with consolidated billing/payment platforms and/or alternative payment models (bundled payments) (preferred). • Familiarity with Availity Essentials, payer portals, and EDI standards (preferred). • Familiarity with Genesys, Service Now, and other CRM tools (preferred). • Familiarity with Facility, DME, Behavioral Health, and Stop-Loss claim types (preferred). • Experience in payment integrity, provider relations, or medical billing (preferred). • Must be able to support USA contact center hours. • Must be able to participate in a rotating on-call schedule for urgent member and provider support needs.