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:

The Claims Contact Center Representative serves as a customer facing representative for XO Health, providing exceptional customer experience and satisfaction in support of claim related inquires/activities. This role will provide guidance and solution solving and will identify process improvement and best practice development opportunities to ensure a best-in-class experience for XO Health customers.

Responsibilities include:

Manage incoming and outbound phone calls from/to providers regarding status of claim requests and to answer general questions. Call types will include: medical benefits, eligibility, and claims; terminology and plan design; billing inquiries; pharmacy benefits, eligibility, and claims; and correspondence requests.
Accurately capture member grievances and file determination requests.
Offer next best actions and follow up appropriately.
Meet the performance goals established for the position in efficiency, call quality, customer satisfaction, compliance, customer follow-up, and attendance.
Respect and maintain HIPAA confidentiality guidelines.
Identify inaccurate/inconsistent information found in systems/tools and communicates to appropriate resources.
Communicate common problems/questions presented by callers to appropriate Subject Matter Experts to drive continuous improvement.
Research and assist team and management with claim projects, claims processing discrepancies, eligibility issues, and claim denials.
Support Claims Operations team in claims processing activities.
Maintain a positive and professional demeanor while adhering to company policies and procedures.
Assist with other responsibilities or duties as needed.

Qualifications:

A qualified candidate will have:

5+ years of proven contact center experience evaluating & processing healthcare claims.
Medical claims operations leadership experience.
Strong knowledge of medical terminology, health insurance plans, medical billing concepts.
Understanding of Facility, Facility Stop Loss, DME, Behavioral Health, Coordination of Benefits claims processing.
Strong attention to detail.
Clear and effective verbal communication skills.
Strong listening skills to understand customer needs and concerns.
Ability to empathize with customers and demonstrate patience.
Calm and composed demeanor while handling customer issues.
Flexibility to adapt to changes in procedures, products, or requirements.

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

$50,000—$55,000 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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