Healthcare Support Representative

XO Health Inc.

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.

Posted 7/20/2026full-timeRemote • 🇮🇳 IndiaMid-LevelSenior💰 ₹500,000 - ₹1,500,000 per yearWebsite

Core Competencies

Role fit

Core Competencies

Use this summary to align your resume positioning with the role.

Demonstrates expertise in healthcare payer operations, including claims processing, member and provider support, and compliance with regulations such as HIPAA and ERISA. Proficient in managing inquiries and resolving issues with a focus on accuracy, customer satisfaction, and operational efficiency.

Highest-signal resume keywords

Claims ProcessingHealth Insurance KnowledgeCustomer Service SkillsAnalytical Problem-SolvingMicrosoft Office Proficiency

ATS Keywords

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Applicant Tracking System Keywords

Tip: use these terms in your resume and cover letter to boost ATS matches.

Hard Skills

Claims AdjudicationEligibility VerificationMedical TerminologyBilling and ReimbursementPrior AuthorizationQuality AssuranceData DocumentationOverpayment ReviewClaims Lifecycle ManagementProcess Improvement

Soft Skills

EmpathyAttention to DetailMultitaskingCommunication SkillsSound Judgment

Tools & Technologies

Claims Processing SystemsCustomer Service SoftwareXO SystemsMicrosoft Office Suite

Industry Keywords

Healthcare PayerTPAHealth InsuranceHIPAA ComplianceERISA ComplianceMember-Provider SupportClaims OperationsService ExcellenceOperational GuidancePerformance Goals

About the role

Key responsibilities & impact

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

What you’ll need

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.

Benefits

Comp & perks

🌐 Worldwide ❌ Jobs You've Hidden ⭐️ Saved Jobs ✅ Applied Jobs ✉️ Email Alerts 👤 Account XO Health Inc. Website LinkedIn All Job Openings 11 - 50 employees ⚕️ Healthcare Insurance ☁️ SaaS 🤝 B2B Healthcare Insurance
SaaS
B2B XO Health Inc. is a company that provides comprehensive, tech-enabled health benefit solutions specifically designed for the self-insured market. Their services cater to self-insured employers, brokers and consultants, and third-party administrators, aiming to unify the healthcare experience. XO Health offers a value-based provider network, member advocacy and care navigation, integrated medical and pharmacy plans, and employer stop-loss coverage. Their solutions are focused on balancing cost and quality, providing flexible and tailored healthcare solutions for employers. Healthcare Support Representative Job not on LinkedIn 🔥 16 minutes ago 🇮🇳 India – Remote 💵 ₹500k - ₹1.5M / year ⏰ Full Time 🟡 Mid-level 🟠 Senior 💝 Customer Support Apply Now Find Hiring Managers Customize resume + cover letter Report problem ☆ Save ☑️ Mark as applied ❌ Hide 📋 Description
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.
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