Healthcare Benefit Navigator

Job Summary:

Our healthcare organization seeks a highly skilled and empathetic Healthcare Benefit Navigator to work remotely and occasionally attend meetings at our Round Rock or Dallas, Texas offices. As a Benefit Navigator, you will answer inbound calls from members, healthcare providers, and internal vendors. During the calls, you will provide information, assistance, and guidance to help callers navigate their healthcare needs. Patient advocacy, appointment scheduling, provider outreach all on behalf of the member and employer confirming satisfaction and any additional support.  

Duties & Responsibilities:

• Answer inbound calls from members, healthcare providers, internal departments, and others.
• Assist members with questions about healthcare benefits, claims, and coverage issues.
• Provide guidance and support to members in understanding and accessing their complex healthcare services.
• Communicate with referral platform partners to create and manage patient referrals.
• Navigate plan documentation to answer member inquiries.
• Research and direct member calls to our vendor partners.
• Assist members with identifying and coordinating high-quality, low-cost healthcare services.
• Work collaboratively with other healthcare organizations to resolve complex member issues and concerns.
• Escalate complex cases to management and clinical support as needed.
• Document all calls and member interactions accurately and thoroughly our the case tracking software.
• Participate in ongoing training and education to stay current with workflows as well as company policies and procedures.
• Willingness to collaborate on special projects as assigned.

Qualifications:

• 1 years of experience in a healthcare customer service role, preferably in a complex environment.
• Excellent verbal and written communication skills.
• Resourceful and able to think quickly in a fast-paced environment.
• Ability to handle high volumes of calls effectively and efficiently.
• Strong attention to detail and ability to document accurately and thoroughly.
• Empathetic and compassionate approach to customer service.
• Ability to work remotely with a reliable high-speed internet connection, in a work area free from distractions.
• Ability to occasionally attend in-office meetings at our Round Rock or Dallas, Texas offices.
• Familiarity with medical terminology and employer self-insurance.
• Proficiency with Microsoft Office, Zendesk, Ring Central and website navigation.
• Ability to Speak and write Spanish fluently is a plus.

We recognize the importance of work-life balance and offer a primarily remote work environment, occasional in-office meetings, competitive salary, comprehensive benefits package, and ongoing training and support. We encourage you to apply for this rewarding opportunity if you are passionate about customer service and helping others with their healthcare needs.