Member Navigator

<h3>Accountabilities</h3><li>
<strong>Member Support and Communication:</strong>Serve as the primary non-clinical contact for members through phone, email, and other communication channels, providing timely, professional, empathetic, and accurate assistance.</li><li>
<strong>Benefits and Program Education:</strong>Explain healthcare programs, eligibility requirements, benefits, available services, provider options, applicable processes, and next steps in clear, accessible language.</li><li>
<strong>Information Collection and Verification:</strong>Gather, verify, and document member demographics, eligibility details, benefits information, referrals, service requirements, and other relevant case information.</li><li>
<strong>Case Management and Resolution:</strong>Manage assigned member cases from initial intake through resolution, research questions, resolve routine issues independently, monitor progress, and coordinate follow-ups to ensure timely outcomes.</li><li>
<strong>Appointment and Service Coordination:</strong>Coordinate imaging appointments and other applicable healthcare services by identifying appropriate providers, facilitating scheduling, confirming appointment details, and communicating updates to members and providers.</li><li>
<strong>Cross-Functional Collaboration:</strong>Work with case management, clinical staff, clients, providers, and internal departments to coordinate services, support members requiring additional assistance, and facilitate appropriate clinical review when needed.</li><li>
<strong>Escalation and Barrier Resolution:</strong>Identify potential obstacles to care, service delays, sensitive issues, and non-standard requests, escalating clinical or complex matters to the appropriate teams in accordance with established procedures.</li><li>
<strong>Documentation and System Management:</strong>Maintain accurate, complete, and timely records of member interactions, scheduling activities, case progress, outcomes, and follow-up requirements in CRM, scheduling, case management, and other departmental systems.</li><li>
<strong>Provider and Partner Relationships:</strong>Build productive working relationships with healthcare facilities, providers, clients, and external partners to promote effective communication and timely service delivery.</li><li>
<strong>Administrative and Operational Support:</strong>Assist with claims-related activities, administrative tasks, and other operational processes associated with member cases as required.</li><li>
<strong>Quality and Performance:</strong>Meet established service-level agreements, productivity targets, quality standards, documentation requirements, and member satisfaction expectations.</li><li>
<strong>Program Flexibility and Cross-Training:</strong>Maintain up-to-date knowledge of supported programs, policies, systems, and business initiatives, and adapt to different workflows, queues, and responsibilities as operational needs change.</li><li>
<strong>Process Improvement:</strong>Collaborate with colleagues and cross-functional teams to identify opportunities to improve workflows, increase operational efficiency, and enhance the overall member experience.</li><li>
<strong>Compliance and Confidentiality:</strong>Follow established security procedures and applicable healthcare privacy requirements, including protecting sensitive member information in accordance with HIPAA and organizational policies.</li><h2>Requirements</h2><li>
<strong>Education:</strong>High school diploma or GED required.</li><li>
<strong>Relevant Experience:</strong>At least 2 years of experience working in a remote call center environment.</li><li>
<strong>Healthcare or Customer Service Background:</strong>Experience in healthcare scheduling, patient or member access, healthcare operations, insurance, medical office administration, or another related customer support environment.</li><li>
<strong>Customer Service Excellence:</strong>Demonstrated ability to provide courteous, professional, accurate, and timely assistance while maintaining a positive member experience.</li><li>
<strong>Communication Skills:</strong>Excellent verbal and written communication skills, including the ability to explain complex information, healthcare processes, and administrative requirements in an understandable manner.</li><li>
<strong>Attention to Detail:</strong>Strong organizational skills and a high level of accuracy when collecting information, documenting cases, coordinating appointments, and managing follow-up activities.</li><li>
<strong>Problem-Solving:</strong>Ability to research questions, resolve routine issues, recognize situations requiring escalation, and follow established procedures to achieve appropriate outcomes.</li><li>
<strong>Time Management and Multitasking:</strong>Ability to manage multiple cases, meet deadlines, prioritize tasks, and maintain productivity in a fast-paced, service-oriented environment.</li><li>
<strong>Independent Work:</strong>Demonstrated ability to work independently, follow instructions and established workflows, exercise sound judgment within the role's scope, and complete assignments reliably.</li><li>
<strong>Technology Proficiency:</strong>Working knowledge of Microsoft Office applications, including Excel and PowerPoint, and the ability to navigate multiple computer systems and learn new platforms.</li><li>
<strong>Remote Work Readiness:</strong>Must be based in the United States and able to maintain a quiet, distraction-free workspace, reliable internet connectivity, and a secure working environment.</li><li>
<strong>Schedule Availability:</strong>Ability to work full-time, Monday through Friday, during the required hours for your time zone:</li>
<li>Eastern Time: 9:30 a.m. – 6:15 p.m.</li><li>Central Time: 8:30 a.m. – 5:15 p.m.</li><li>Mountain Time: 7:30 a.m. – 4:15 p.m.</li><li>Pacific Time: 6:30 a.m. – 3:15 p.m.</li><li>
<strong>Data Security and Compliance:</strong>Willingness to follow company security policies, use approved devices and software, apply secure access practices such as VPNs and strong passwords, and protect confidential health information.</li><h2>Preferred Qualifications</h2><li>Associate degree or additional relevant education.</li><li>Healthcare experience combined with medical, claims, or collections call center experience.</li><li>Medical terminology certification.</li><li>Experience reading, interpreting, and explaining Explanation of Benefits (EOB) documents.</li><li>Certified Benefits Professional Associate (BCPA) certification.</li><li>Experience coordinating healthcare services, navigating insurance benefits, or supporting patient access and care coordination.</li><h2>Benefits</h2><li>
<strong>Comprehensive Healthcare Coverage:</strong>Generously subsidized medical, dental, and vision insurance, including access to services through company healthcare products.</li><li>
<strong>Health and Spending Accounts:</strong>Health Savings Account (HSA), Flexible Spending Account (FSA), and Dependent Care Flexible Spending Account (DCFSA) options.</li><li>
<strong>Retirement Savings:</strong>401(k) plan with company matching contributions and immediate vesting.</li><li>
<strong>Fully Remote Work:</strong>Work from home anywhere in the United States, with the necessary equipment provided.</li><li>
<strong>Flexible Work Environment:</strong>Remote working arrangements designed to support productivity and work-life balance.</li><li>
<strong>Paid Time Off:</strong>Generous PTO, including vacation, sick leave, and paid holidays.</li><li>
<strong>Parental Leave:</strong>Paid maternity and paternity leave to support growing families.</li><li>
<strong>Employee Assistance Program:</strong>Access to professional counseling, referrals, and additional personal and work-life support services.</li><li>
<strong>Pet Insurance:</strong>Optional coverage to help manage eligible veterinary expenses.</li><li>
<strong>Employee Discounts:</strong>Savings on phone plans, car rentals, computers, and other eligible purchases.</li><li>
<strong>Community Engagement:</strong>Opportunities to participate in philanthropic initiatives, including paid time off for community service.</li><li>
<strong>Professional Development:</strong>Opportunities to gain experience across healthcare programs, strengthen member service skills, and develop knowledge of healthcare operations.</li><li>
<strong>Purpose-Driven Culture:</strong>The opportunity to contribute to improving healthcare access, cost transparency, service quality, and the overall member experience.</li>