Healthcare Support Representative
Employment Information
Report this job
Job expired or something wrong with this job?
Job Description
Operations Specialist handling member and provider inquiries and claims processing for XO Health. Engaging in advocacy, claims resolution, and cross-functional collaboration within a remote team.
Responsibilities:
- Handle inbound and outbound member and provider inquiries via phone, email, and chat with professionalism and empathy.
- Initiative member outreach to provide information and assistance regarding benefits.
- Provide accurate information regarding benefits, eligibility, and coverage; claims status and adjudication details; prior authorization requirements and submissions; billing and reimbursement policy questions; and provider portal navigation and support.
- Resolve inquiries, complaints, grievances, and escalations promptly while ensuring complete documentation and proper routing when needed.
- Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes.
- Build trust with members and providers through early, frequent, and personalized engagement.
- 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.
- 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.
- 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 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.
Requirements:
- 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.
Similar Jobs
Customer Support Representative, Czech/Slovak, English
Remote Customer Support Representative helping customers in Czech and Slovak languages. Engaging with international teams and providing professional support via phone and email.
Dutch Speaking Customer Service Representative
Digital Financial Solutions Specialist acting as a customer support representative for a leading fintech company. Offering expert guidance and support in managing online transactions.
Customer Success & Logistics Coordinator – High-Ticket Client Experience
Customer Success & Logistics Coordinator for a premium lifestyle brand. Delivering exceptional experiences from purchase through delivery while ensuring customer satisfaction.
Customer Service Specialist – 2nd Shift
Customer Service Specialist handling inbound customer calls for QVC. Promoting products and assisting with problem-solving while working from home.
Customer Service Specialist – 2nd Shift
Customer Service Specialist handling high volume inbound customer inquiries for QVC Group. Assisting customers with questions and offering product promotions while working remotely from home.
Working Student – Customer Support
Working Student managing inbound customer support via voice, chat, and email for AI companions provider. Collaborating with technical support and covering evening and weekend shifts in Hamburg.
Customer Care Representative
Customer Care Representative handling customer inquiries and scheduling services for a home services company in California. Responsible for sales, education, and support within customer care.
Learning Experience Designer, Customer Enablement
Learning Experience Designer facilitating customer training and support for Laivly's AI solutions. Transforming complex product functionality into engaging learning for customer success.
Customer Support Intern
Praktikant im Customer Support bei LWB Group, einem Tierversicherungs-Startup, das digitales Marketing und Sales Prozesse optimiert.
Customer Service Representative
Call Center Representative handling customer inquiries for Precision Pipeline Solutions. Providing customer support and resolving issues while working from home in New York.
Field Support Representative, Customer Success
Field Support Representative assisting Sidecar Health members in Ohio with their healthcare journeys. Collaborating with teams to ensure members utilize their benefits effectively.
Senior B2B Customer Service Representative
B2B Sr. Customer Service Representative managing customer relationships and inquiries for Stanley Black & Decker. Collaborating effectively with sales and service personnel to exceed expectations.
Customer Care Specialist – Hungarian, Polish, English
Customer Care Specialist providing multilingual support for logistics at Trimble. Helping resolve client inquiries with a focus on technology and customer experience.
Senior Recipient Support Specialist
Senior Recipient Support Specialist at Advanced Bionics providing technical and clinical support for cochlear implant recipients. Collaborating with various teams to ensure exceptional recipient outcomes.
Employee Benefits Customer Service Representative
Employee Benefits Customer Service Representative for Foundation Risk Partners handling benefits inquiries and claims resolution for clients. Collaborating with clients and carriers through phone and email for timely resolution.
Manager, Customer Experience Technology
Manager of Customer Experience Technology overseeing technology platforms affecting customer experience at Cable One. Collaborating with various departments to ensure platform success and enhancement.
Bilingual Gaming Customer Support – Simplified Chinese, English
Gaming Support Representative assisting players in Simplified Chinese and English with technical and gameplay issues while delivering excellent customer service.
Customer Service Representative, Bilingüe Inglés B2/C1
Customer Service Representative offering support to US personal injury clients. Must handle client communication and service coordination while working remotely.
Asesor de Atención al Cliente y Ventas
Customer Service and Sales Advisor resolving customer queries for Entel Perú. Managing sales and cross-selling over the phone in a fully remote role.
Customer Support Specialist I – Software
Customer Support Specialist I at foreUP, handling inquiries and technical issues for customers. Delivering excellent service while managing tickets for various SaaS applications related to golf course management.