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XO Health Healthcare Support Advocate

About the Role:

Remote- USA -Virtual Contact Center

The Healthcare Support Advocate is a key member of XO Health's operations team, supporting both member and provider services through our virtual contact center. This role serves as a primary point of contact for members and providers through an omni-channel environment (phone, email, chat).

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 Healthcare Support Advocate 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:

Member & Provider Advocacy

• 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, and coverage; claims 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 promptly while ensuring complete documentation and proper routing when needed.
• Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes.
• Build trust with members and providers through early, frequent, and personalized engagement.

Cross-Functional Collaboration & Continuous Improvement

• Collaborate with Claims Operations, Network Operations, and Account Management teams to resolve complex cases and improve service delivery.
• Identify recurring issues, system gaps, or process inefficiencies and provide feedback to leadership.

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 must have:

• 3-5 years of experience in a healthcare payer, TPA, or health insurance environment, with a blend of contact center/member-provider support.
• Strong knowledge of health insurance concepts, benefits and eligibility, medical terminology, and claims lifecycle management.
• Strong English language 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 while maintaining accuracy and professionalism.
• 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.
• Familiarity with Availity Essentials, payer portals, and EDI standards.
• Familiarity with Genesys, Service Now, and other CRM tools
• Familiarity with Facility, Physician, Ancillary, and Behavioral Health, claim types.
• Spanish language proficiency (written and verbal) is a plus.

Additional Details:

• Must be able to support contact center hours of 8:00am - 5:30pm ET.
• Must be able to participate in a rotating on-call schedule for urgent member and provider support needs.