XO Health believes healthcare is fixable. Become 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 receive 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.
XO Health: Claims Analyst
About the job
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, India - Claims Analyst
The Claims Analyst is a key member of XO Health’s operations team, supporting claims processing and resolution (Claims Operations).
This role serves as a primary point of contact for members and providers through an omni-channel environment (phone, email, chat), while also functioning as a claim’s operations expert responsible for accurate claim processing, research, adjudication, adjustments, and issue resolution.
This position requires a strong service-first mindset, high attention to detail, and the ability to move seamlessly between real-time support and behind-the-scenes operational work. The Claims Analyst partners cross-functionally with internal teams and third-party vendors to ensure members and providers receive timely, compliant, and high-quality support across the operations.
Key Responsibilities:
Claims Processing, Adjudication & Resolution
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.
Provider Data, Outreach & Operational Support
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.
Cross-Functional Collaboration & Continuous Improvement
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.
Performance & Compliance Expectations
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.
Experience Required:
The qualified candidate will have:
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…