XO Health Inc. is hiring a
Claims Contact Center Representative

Summary

Join the community changing the face of healthcare at XO Health! As a Claims Contact Center Representative, you'll provide exceptional customer experience and satisfaction in support of claim related inquiries/activities. This role will guide customers through medical benefits, eligibility, and claims; terminology and plan design; billing inquiries; pharmacy benefits, eligibility, and claims; and correspondence requests.

Requirements

• 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

Responsibilities

• Manage incoming and outbound phone calls from/to providers regarding status of claim requests and to answer general questions
• 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