XO Health Inc.

Customer Support

• 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.

Healthcare Support Representative

ServiceNow

• Partner with ServiceNow Architect in building and rolling out a scalable, enterprise-grade platform.
• Configure, develop, test, and deploy ServiceNow Customer Service Management (CSM) and Healthcare & Life Sciences (HCLS) modules.
• Create and enhance the Customer Service Portal and Member/Provider portals using Service Portal Designer and UI Builder.
• Develop integrations via REST/SOAP APIs and automate batch transfers.

Healthcare Support Representative

ServiceNow Engineer