Member Care Navigator (On-Site or Remote)

• →Deliver a high‑empathy, member‑first experience in every interaction.
• →Acknowledge frustration, build trust, and help members confidently navigate their benefits.
• →Explain open‑network plans, reference‑based pricing, and member benefits in simple, jargon‑free language.
• →Own each case through resolution with proactive updates and follow‑through.
• →Document all interactions thoroughly and accurately to ensure continuity of care, compliance, and quality.

• Liaise professionally with providers to clarify plan details, payment processes, and network structure.
• Navigate provider pushback with calm, respectful communication.
• Identify accepting or RBP‑friendly facilities and provide alternative options when needed.
• Coordinate Single Case Agreements (SCAs) or escalations based on internal criteria.
• Investigate delays or barriers that threaten timely care and act decisively to overcome them.

• Follow established workflows, boundaries, and escalation protocols with precision.
• Use internal research tools (OnPoint, PON, provider lookup systems) to verify provider options.
• Prioritize inquiries based on urgency, member risk, and available details.
• Collaborate across departments to establish processes that remove barriers to care.
• Uphold compliance standards, including HIPAA and Department of Labor guidelines.
• Maintain confidentiality of all sensitive information.

• High school diploma or equivalent required.
• Foundational understanding of medical cost containment products (RBP, out‑of‑network, access coordination).
• Knowledge of CPT codes, claims forms, or general medical insurance preferred.
• Experience in healthcare navigation, patient access, medical office operations, insurance verification, case management, or high‑emotion customer service environments strongly preferred.
• Exceptional verbal and written communication skills.
• Empathy, emotional resilience, and the ability to stay calm under pressure.
• Strong judgment and ability to navigate sensitive or ambiguous situations.
• Persistent, detail‑oriented, and committed to accurate documentation.
• Ability to manage multiple tasks simultaneously and adapt to frequent changes.
• Skilled in problem‑solving and anticipating member needs.
• Bilingual (Spanish) preferred.

• A successful Care Navigator consistently demonstrates:
• High‑quality member experience characterized by trust, clarity, and empathy.
• Timely and accurate case documentation and workflow adherence.
• Ability to professionally overcome provider resistance.
• Strong cross‑functional collaboration.
• Sound judgment, composure, and reliability under pressure.
• Ownership and follow‑through on all assigned cases.

• Fast‑paced, member‑centric operations setting.
• Frequent balancing of urgent inquiries, provider calls, and detailed research.
• Highly collaborative environment with emphasis on communication, teamwork, and adaptability.
• Culture built around mindfulness, problem‑solving, and “outward mindset” principles.

Ready to apply? If this job sounds like a fit for you, then click on the ‘apply’ button below. Good luck!

• We pride ourselves on our outward mindset – supporting each other and putting the team and the clients we serve first
• High-growth environment with clear opportunities for career growth
• Welcoming atmosphere and culture