XO Health is the first health plan designed by and for self-insured employers that delivers a more unified health experience for everyone – from those who receive care, to those who deliver it, to those who pay for it.

We are growing a multi-disciplinary team of diverse and digitally empowered employees ready to rebuild trust in healthcare through comprehensive and unified transformation.

About the Role:

As a key member of the Advocacy and Connected Care Team, the XO Health Advocate will be the primary contact for members, offering guidance, education, and support regarding their health insurance coverage and benefits options. Your role will ensure that members have a positive experience and are empowered to make informed healthcare decisions.

The XO Health Advocate specializes in providing empathetic, holistic care, focusing on delivering a highly personalized healthcare experience. By leveraging a fully tech-enabled, omni-channel approach, you will enhance trust and engagement through early and frequent interactions, meeting individuals where they are on their health journey.

Responsibilities include:

Handle Inbound Calls: Respond to incoming calls from members and providers with professionalism and empathy.
Provide Information: Offer accurate information about health plan benefits, coverage, and services.
Resolve Issues: Address and resolve inquiries, concerns, and complaints promptly and effectively.
Assist with Claims: Provide support with claims processing and status updates.
Guide Members and Providers: Assist members and providers with navigating our health plan services, including authorizations, referrals, and eligibility.
Document Interactions: Accurately document all interactions and maintain detailed records in our customer service system.
Follow Up: Conduct follow-up calls as necessary to ensure resolution and satisfaction.
Collaborate: Work closely with other departments to resolve complex issues and improve service delivery.
Stay Informed: Keep up to date with changes in health plan policies, procedures, and industry regulations.
On-Call Coverage: Provide on-call support as needed to address urgent issues outside regular business hours.

Benefits Education and Enrollment Assistance:

Provide comprehensive education to members regarding their health insurance benefits, coverage options, and enrollment processes.
Assist members in navigating online portals or paper forms to enroll in or make changes to their benefits coverage.
Explain complex insurance terms and concepts in a clear and understandable manner to enhance member understanding.

Covrage Verification and Eligibility Assessment:

Verify member eligibility for specific benefits and services based on their insurance plan and policy provisions.
Conduct thorough reviews of member coverage details, including deductibles, copayments, coinsurance, and out-of-pocket maximums.
Address member inquiries regarding coverage limitations, exclusions, and pre-authorization requirements.

Benefits Explanation and Clarification:

Answer member inquiries regarding benefit details, such as in-network and out-of-network coverage, prescription drug coverage, and preventive care services.
Clarify benefit utilization processes, including prior authorization, referrals, and claims submission procedures.
Provide examples and scenarios to illustrate how members can effectively utilize their benefits to access necessary healthcare services.

Claims Assistance and Dispute Resolution:

Assist members in understanding their medical claims, including explanations of benefits (EOBs), claim denials, and reimbursement processes.
Redirect member concerns or disputes related to claim processing, billing errors, and coverage discrepancies.
Liaise with internal departments, external providers, and third-party administrators to expedite claims resolution and ensure member satisfaction.

Benefits Optimization and Cost-Saving Strategies:

Educate members on cost-saving strategies, such as utilizing in-network providers, generic medication options, and telehealth services.
Identify opportunities for members to maximize their benefits coverage while minimizing out-of-pocket expenses.
Offer guidance on navigating benefit tiers, formularies, and preferred provider networks to optimize coverage.

Member Empowerment and Advocacy:

Empower members to become active participants in their healthcare decision-making by providing them with the knowledge and tools necessary to navigate their benefits effectively.
Advocate on behalf of members to resolve benefit-related issues, escalate concerns as needed, and ensure timely resolution of inquiries.
Foster a supportive and empathetic environment that prioritizes member needs and fosters trust and confidence in the health insurance carrier.
The ability to identify emerging patterns to proactively mitigate potential issues for future members.
Actively engaged in the feedback loop to continually improve processes and services, contributing to the ongoing enhancement of XO's offerings.

Qualifications:

The qualified candidate will have:

Bachelor's degree in healthcare administration, business administration, Social Services or related field preferred.
3-5 Previous experience in a call center environment, preferably in a healthcare or insurance setting.
Excellent verbal and written communication skills with a strong ability to listen actively.
Strong analytical and problem-solving skills to address and resolve issues effectively.
Proficiency in using computer systems, including customer service software and Microsoft Office Suite.
Ability to build rapport and maintain positive relationships with members and providers.
Ability to manage multiple tasks efficiently in a fast-paced environment.
Collaborative attitude with a commitment to team success and the ability to work cross-functionally with other disciplines.
Flexibility to adapt to changing procedures and environments.
Must be knowledgeable about insurance benefits, coverage, and healthcare regulations.
Must be able to work within an omnichannel environment, including phone, email, chat, and other digital communication platforms.
Ability to travel for in-person training sessions as required.
Must be available for the in-person launch on January 1, 2025.

Preferred Skills:

Healthcare Knowledge: Understanding of health insurance, medical terminology, and healthcare regulations.
Bilingual: Proficiency in a second language is a plus, especially Spanish.

Full compensation packages are based on candidate experience and relevant certifications.

$65,000—$75,000 USD

XO Health is an equal opportunity employer committed to diversity and inclusion in the workplace. All qualified applicants will receive consideration for employment without regard to sex (including pregnancy, childbirth or related medical conditions), race, color, age, national origin, religion, disability, genetic information, marital status, sexual orientation, gender identity, gender reassignment, citizenship, immigration status, protected veteran status, or any other basis prohibited under applicable federal, state or local law. XO Health promotes a drug-free workplace.

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