Health Operations Specialist
Posted on February 21, 2026 (3 months ago)
This job post is archived - the company is no longer hiring for this position.
Check out other job posts of this company here!Health Operations Specialist
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.
Position Overview
This is a remote role based in India supporting USA virtual contact center and claims operations hours. The Operations Specialist supports both member/provider service (Advocacy) and claims processing and resolution (Claims Operations).
This blended 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 claims operations expert responsible for accurate claim processing, research, adjudication, adjustments, and issue resolution. The role requires a service-first mindset, high attention to detail, and the ability to move between real-time support and operational work.
Key Responsibilities
- Handle inbound and outbound member and provider inquiries via phone, email, and chat with professionalism and empathy.
- Initiate member outreach to provide information and assistance regarding benefits.
- Provide accurate information regarding benefits, eligibility, coverage, claim 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 with complete documentation and proper routing when needed and perform follow-up outreach to ensure resolution and satisfaction.
- 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, billing errors, and payment issues; conduct overpayment reviews and coordinate recovery actions as required.
- Support high-cost claim and claimant processes as needed and perform quality assurance reviews to ensure claims financial and procedural accuracy.
- Perform provider outreach to support claims resolution, documentation needs, and payment accuracy; collect W-9s and maintain accurate provider information within XO systems.
- Collaborate with Business Operations, Network Performance, Product, and Experience teams and third-party claims vendors to resolve complex cases and improve service delivery.
- Identify recurring issues, system gaps, or process inefficiencies and document procedures, workflows, and operational guidance as needed.
Performance and Compliance Expectations
Meet performance goals in efficiency, 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
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, 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; high attention to detail, sound judgment, and analytical problem-solving skills.
Proficiency in Microsoft Office Suite and customer service and/or claims processing systems.
Preferred Skills
- Associate or bachelor’s degree in healthcare administration, business, or a related field.
- Experience with consolidated billing/payment platforms, alternative payment models (bundled payments), Availity Essentials, payer portals, EDI standards, Genesys, ServiceNow, or 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) is a plus.
Additional Details
Must be able to support USA contact center hours and participate in a rotating on-call schedule for urgent member and provider support needs.
Compensation
Full compensation packages are based on candidate experience and relevant certifications. Range shown on the posting: 1,000,000 - 1,500,000 INR annually.
Equal Opportunity
XO Health is an equal opportunity employer committed to diversity and inclusion. All qualified applicants will receive consideration without regard to legally protected characteristics. XO Health promotes a drug-free workplace.
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