Claims Contact Center Representative

About the role:

The Claims Contact Center Representative serves as a customer facing representative for XO Health, providing exceptional customer experience and satisfaction in support of claim related inquires/activities. This role will provide guidance and solution solving  and will identify process improvement and best practice development opportunities to ensure a best-in-class experience for XO Health customers.

Responsibilities include:

• Manage incoming and outbound phone calls from/to providers regarding status of claim requests and to answer general questions. Call types will include: medical benefits, eligibility, and claims; terminology and plan design; billing inquiries; pharmacy benefits, eligibility, and claims; and correspondence requests.
• Accurately capture member grievances and file determination requests.
• Offer next best actions and follow up appropriately.
• Meet the performance goals established for the position in efficiency, call quality, customer satisfaction, compliance, customer follow-up, and attendance.
• Respect and maintain HIPAA confidentiality guidelines.
• Identify inaccurate/inconsistent information found in systems/tools and communicates to appropriate resources.
• Communicate common problems/questions presented by callers to appropriate Subject Matter Experts to drive continuous improvement.
• Research and assist team and management with claim projects, claims processing discrepancies, eligibility issues, and claim denials.
• Support Claims Operations team in claims processing activities.
• Maintain a positive and professional demeanor while adhering to company policies and procedures.
• Assist with other responsibilities or duties as needed.

Qualifications:

A qualified candidate will have:

• 5+ years of proven contact center experience evaluating & processing healthcare claims.
• Medical claims operations leadership experience.
• Strong knowledge of medical terminology, health insurance plans, medical billing concepts.
• Understanding of Facility, Facility Stop Loss, DME, Behavioral Health, Coordination of Benefits claims processing.
• Strong attention to detail.
• Clear and effective verbal communication skills.
• Strong listening skills to understand customer needs and concerns.
• Ability to empathize with customers and demonstrate patience.
• Calm and composed demeanor while handling customer issues.
• Flexibility to adapt to changes in procedures, products, or requirements.