Claims Analyst

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, compli