Remote Claims Analyst – Healthcare Payer Ops

XO Health Inc.; États-Unis; À distance; USD 5 300 - 16 000; Plein temps

Résumé du poste

XO Health Inc. is seeking a Claims Analyst to support member/provider advocacy and claims operations in a remote setting for USA and India.

You will handle inquiries via phone, email, and chat, process and adjudicate claims, verify eligibility, and resolve denials or errors with a focus on accuracy and compliance. The role requires 3–5 years in healthcare payer environments, strong communication, and proficiency with claims systems.

Qualifications

• 3–5 years of experience in a healthcare payer, TPA, or health insurance environment.
• Knowledge of health insurance concepts, benefits and eligibility, medical terminology, and claims lifecycle.
• 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.
• Proficiency in Microsoft Office Suite and claims processing systems.

Responsabilités

• Handle inbound and outbound member and provider inquiries via phone, email, and chat with professionalism and empathy.
• Provide information regarding benefits, eligibility, coverage; claims status and adjudication details; prior authorization requirements and submissions.
• Resolve inquiries, complaints, grievances, and escalations promptly with complete documentation.
• Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes.
• Collaborate with cross-functional teams to resolve complex cases and improve service delivery.
• Coordinate with third-party claims vendors to maintain accuracy, compliance, and service excellence.
• Perform quality assurance reviews to ensure claims financial and procedural accuracy.

Connaissances

Healthcare payer knowledge

Claims processing & adjudication

Customer service & empathy

Attention to detail

Analytical problem solving

Microsoft Office

English communication

Formation

Bachelor's or Associate degree in healthcare administration or related field

Outils

Genesys

ServiceNow

Availity Essentials

Payer portals

CRM tools

Description du poste

XO Health Inc. is seeking a Claims Analyst to support member/provider advocacy and claims operations in a remote setting for USA and India.

You will handle inquiries via phone, email, and chat, process and adjudicate claims, verify eligibility, and resolve denials or errors with a focus on accuracy and compliance. The role requires 3–5 years in healthcare payer environments, strong communication, and proficiency with claims systems.