Claims Analyst

XO Health Inc.; Bengaluru; Remote; INR 500,000 - 1,500,000; Full time

Job summary

XO Health Inc. is seeking a diligent Claims Analyst to support claims processing, adjudication, and resolution in a remote setup serving USA and India markets. You will handle omni‑channel member/provider interactions and work across teams to ensure timely, accurate claims outcomes.

Ideal candidates bring 3–5 years in healthcare payer environments, solid knowledge of claims lifecycle, and strong communication skills to deliver compliant, high‑quality support daily.

Qualifications

• 3–5 years of experience in a healthcare payer, TPA, or health insurance environment with claims processing experience.
• Strong knowledge of health insurance concepts, benefits and eligibility, and claims lifecycle.
• 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.

Responsibilities

• Process, research, and adjudicate institutional and professional medical claims (including behavioral health).
• Verify eligibility, coverage, and medical necessity under policy guidelines.
• Investigate and resolve claim denials, appeals, discrepancies, overpayments, and payment issues.
• Coordinate with providers and third‑party vendors to maintain accuracy and service excellence.
• Document procedures, workflows, and operational guidance as needed.

Skills

Healthcare payer knowledge

Claims processing

Customer service

English communication

Analytical problem‑solving

Education

Associate or bachelor’s in healthcare administration or related field

Tools

Availity Essentials

Payer portals

Genesys

ServiceNow

CRM tools

Microsoft Office

Job description

XO Health believes healthcare is fixable. Become part of the community changing the face of the industry. 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.

XO Health: Claims Analyst

About the job. XO Health believes healthcare is fixable. Become a part of the community changing the face of the industry. 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 received 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:

Remote- USA, India - Claims Analyst

The Claims Analyst is a key member of XO Health's operations team, supporting claims processing and resolution (Claims Operations).

This role serves as a primary point of contact for members and providers through an omni-channel environment (phone, email, chat), while also functioning as a claim's operations expert responsible for accurate claim processing, research, adjudication, adjustments, and issue resolution.

This position requires a strong service-first mindset, high attention to detail, and the ability to move seamlessly between real-time support and behind-the-scenes operational work. The Claims Analyst partners cross-functionally with internal teams and third-party vendors to ensure members and providers receive timely, compliant, and high-quality support across the operations.

Key Responsibilities:

Claims Processing, Adjudication & Resolution

• 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, and 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.

Provider Data, Outreach & Operational Support

• 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 to support claims processing, reporting, directory publication, and data transfers.

Cross-Functional Collaboration & Continuous Improvement

• 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.

Performance & Compliance Expectations

• Meet performance goals in areas such as efficiency and productivity, quality and accuracy, customer satisfaction, compliance, follow-up completion, and attendance.
• Maintain confidentiality and compliance with HIPAA, ERISA, and XO Health policies.

Experience Required:

• 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.

Preferred Skills:

• 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) is a plus.

Additional Details:

• 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.

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

₹500,000—₹1,500,000 INR

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.