Healthcare Customer Support Representative

Healthcare Customer Support Representative - India (Remote)

Position Overview 

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-Virtual Contact Center.

As a key member of the XO Health Advocacy team, you will be the primary contact for members and providers, offering guidance, education, and support regarding their health insurance coverage and benefits options as well as assisting providers regarding claims and eligibility questions. Your role will ensure that members and providers have a positive experience and are empowered to make informed healthcare decisions.

The XO Health Advocate specializes in providing empathetic, holistic support, focusing on delivering a highly personalized experience. By leveraging an omni-channel approach, you will enhance trust and engagement through early and frequent interactions, meeting individuals where they are on their health journey. This role requires a high degree of professionalism, operational rigor, and a service-first mindset

 Key Responsibilities:

• Handle Inbound Calls, e-mails and chats: Respond to incoming calls from members and providers with professionalism and empathy.
• Offer accurate information about health plan benefits, coverage, services and claims.
• Resolve Issues: Address and resolve inquiries, concerns, and complaints promptly and effectively.
• Assist with Claims: Provide support with claims processing and status updates.
• Guide Members and Providers: Assist members and providers in navigating our health plan services, including authorizations, referrals, and eligibility.
• Document Interactions: Accurately document all interactions and maintain detailed records in our customer service system.
• Follow Up: Conduct follow-up calls as necessary to ensure resolution and satisfaction.
• Collaborate: Work closely with other departments to resolve complex issues and improve service delivery.
• Support members and providers with eligibility and benefits questions and concerns
  • Claims status and adjudication details
  • Prior authorization requirements and submissions
  • Reimbursement policy questions
  • Provider portal navigation
  • W-9 collection
• As needed, maintain accurate and timely provider data updates in XO systems to support claims processing, reporting, directory publication, and data transfers.
• Meet the performance goals established for the position in the areas of efficiency, call quality, customer satisfaction, compliance, customer follow-up, and attendance.

 Experience Required:

The qualified candidate will have:

• Bachelor’s degree; OR 3 - 5 years of contact center experience, preferably in healthcare or insurance, may be substituted in lieu of degree.
• Excellent verbal and written communication skills with a strong ability to listen actively.
• Strong analytical and problem-solving skills to address and resolve issues effectively.
• Proficiency in using computer systems, including customer service software and Microsoft Office Suite.
• Ability to build rapport and maintain positive relationships with members and providers.
• Ability to manage multiple tasks efficiently in a fast-paced environment.
• Collaborative attitude with a commitment to team success and the ability to work cross-functionally.
• Flexibility to adapt to changing procedures and environments.
• Familiarity with insurance benefits, coverage, and healthcare regulations.
• Must be able to work within an omnichannel environment, including phone, email, chat, and other digital communication platforms.

Preferred Skills:

• Healthcare Knowledge
• Experience working with consolidated billing/payment platforms.
• Familiarity with alternative payment models (e.g., bundled payments).
• Familiarity with provider tools including Availity Essentials, payer portals, and EDI standards.
• Bilingual: Proficiency in a second language is a plus, especially Spanish.

 Additional Details:

Availability: Must be able to support USA contact center hours and participate in a rotating on-call schedules to assist with urgent member and provider support needs.