Care Navigator

Role DescriptionThe Care Navigator plays a pivotal role in ensuring our members fully understand and effectively utilize their benefits. This role requires an understanding of insurance terminology, and excellent communication skills. The ideal candidate will demonstrate empathy, patience, and strong problem-solving abilities to deliver a positive experience for members during their healthcare journey.

Responsibilities

Member Assistance and Concierge Support

• Provide comprehensive support to members, helping them to understand and maximize their Episode Advantage benefits.
• Respond to inquiries via phone, email, or chat, offering clear and accurate information to resolve questions and concerns.
• Initiate outgoing communication to assist members in utilizing their benefits.
• Clearly explain details of Episode Advantage benefits, including covered services, benefit allowance, eligibility, co-payments, deductibles, and any limitations or exclusions.
• Guide members in using the member portal, focusing on functionalities related to Episode Advantage benefits to optimize their overall benefits usage.
• Handle and escalate member complaints, ensuring timely and satisfactory resolution.

Episode Selection and Care Group Search and Confirmation

• Assist and guide members to search for episodes of care and corresponding care groups and guaranteed pricing.
• Ensure members understand the value to them of selecting the appropriate site of care and care group for their need.
• Provide clinical guidance and information to members

Qualifications

• Knowledge of healthcare benefit plans and insurance terminology.
• Excellent communication and interpersonal skills.
• Empathetic, patient, and strong problem-solving abilities.
• Demonstrated ability to manage tasks in an orderly and efficient manner and maintain organized workflows.
• Experience in customer service, particularly in a healthcare setting, is preferred.
• Proficiency in navigating digital tools and member portals.
• Clinical knowledge including medical terminology and treatment plans preferred.
• Fluent in Spanish strongly preferred.