Job Description: Handle inbound and outbound member and provider inquiries via phone, email, and chat Initiate member outreach regarding benefits Provide information on benefits, eligibility, coverage, claims, prior authorization, billing, reimbursement policies, and provider portal support Resolve inquiries, complaints, grievances, and escalations with complete documentation and proper routing Conduct follow-up outreach to ensure resolution, satisfaction, and continuity of care or claim outcomes Build trust through early, frequent, and personalized engagement Collaborate with Claims Operations, Network Operations, and Account Management teams on complex cases and service improvements Identify recurring issues, system gaps, and process inefficiencies and provide feedback to leadership Meet goals for efficiency, productivity, quality, accuracy, customer satisfaction, compliance, follow-up completion, and attendance Maintain confidentiality and compliance with HIPAA, ERISA, and XO Health policies Requirements: 3–5 years of experience in a healthcare payer, TPA, or health insurance environment, including contact center/member-provider support 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 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 Must support contact center hours of 8:00am–5:30pm ET Must participate in a rotating on-call schedule for urgent member and provider support Preferred: Associate or bachelor’s degree in healthcare administration, business, or related field Preferred: Familiarity with Availity Essentials, payer portals, and EDI standards Preferred: Familiarity with Genesys, ServiceNow, and other CRM tools Preferred: Familiarity with Facility, Physician, Ancillary, and Behavioral Health claim types Spanish proficiency is a plus Benefits: