Claims Analyst

Overview

Claims Analyst on XO Health's operations team, supporting claims processing and resolution and serving as a primary point of contact for members and providers across phone, email and chat.

What you'll do

• 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, 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.
• 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 efficiency, productivity, quality, accuracy, customer satisfaction, compliance, follow-up completion and attendance.
• Maintain confidentiality and compliance with HIPAA, ERISA and XO Health policies.

What you'll need

• 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 or claims operations.
• Strong knowledge of health insurance concepts, benefits and eligibility, medical terminology and claims lifecycle management.
• Strong English 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.

Nice to have

• Associate or bachelor's degree in healthcare administration, business or a related field.
• Experience with consolidated billing/payment platforms and/or alternative payment models (bundled payments).
• Familiarity with Availity Essentials, payer portals and EDI standards.
• Familiarity with Genesys, Service Now and other CRM tools.
• Familiarity with Facility, DME, Behavioral Health and Stop-Loss claim types.
• Experience in payment integrity, provider relations or medical billing.
• Spanish language proficiency (written and verbal).

Details

• Remote, India or USA.
• 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.