Claims Analyst

The role

You will process, research and adjudicate medical claims, including behavioral health claims, and resolve denials, appeals and billing errors. You will also serve as a point of contact for members and providers by phone, email and chat.

What you will do

• Process, research and adjudicate institutional and professional medical claims, including behavioral health
• Verify eligibility, coverage and medical necessity under policy guidelines
• Investigate and resolve claim denials, appeals, discrepancies, overpayments and billing errors
• Conduct overpayment reviews and coordinate recovery actions
• Support high-cost claim and claimant processes as needed
• Perform provider outreach to support claims resolution and documentation
• Collect W-9s and maintain accurate provider information in XO systems
• Work with internal teams and third-party claims vendors to resolve complex cases
• Perform quality assurance reviews of claims financial and procedural accuracy
• Document procedures, workflows and operational guidance

Required qualifications

• 3–5 years of experience in a healthcare payer, TPA or health insurance environment, with contact center/member-provider support and/or medical claims processing, adjudication or claims operations
• Strong knowledge of health insurance concepts, benefits and eligibility, medical terminology and claims lifecycle management
• Strong English 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
• Proficiency in Microsoft Office Suite and customer service and/or claims processing systems

Nice to have

• Associate or bachelor's degree in healthcare administration, business or a related field
• Experience with consolidated billing/payment platforms and/or bundled payment models
• Familiarity with Availity Essentials, payer portals and EDI standards
• Familiarity with Genesys, Service Now and other CRM tools
• Familiarity with Facility, DME, Behavioral Health and Stop-Loss claim types
• Experience in payment integrity, provider relations or medical billing
• Spanish language proficiency (written and verbal)

Before you apply

• Must be able to support USA contact center hours
• Must be able to participate in a rotating on-call schedule

About the company

XO Health is the first health plan designed by and for self-insured employers. It is growing a team focused on a more unified health experience for members, providers and payers.