Care Navigator

This is a fully remote position, open to applicants in United States.

📋 Description

• Act as the main contact for members and providers addressing inbound inquiries related to behavioral health.

• Confirm eligibility and benefits while educating members on available services.

• Assist in processing claims and authorizations while accurately routing calls.

• Ensure adherence to HIPAA regulations.

• Perform behavioral health screenings.

• Arrange appointments and referrals, linking members to network services.

• Elevate crisis situations and clinical issues to the relevant personnel and resources.

• Deliver compassionate customer service and resolve standard claims inquiries.

• Clarify denials and submissions, escalating complicated issues when necessary.

• Collaborate with various teams to enhance processes and implement operational changes.

• Recognize risk indicators during interactions with members.

• Record interactions across multiple systems and handle necessary documentation.

• Manage demographic updates and authorization requests.

• Meet performance metrics along with contractual and service-level expectations.

• Promote teamwork and contribute to positive member care outcomes.

⛳️ Requirements

• High School Diploma.

• Exceptional written and verbal communication abilities.

• Strong organizational and time management skills.

• Proficient problem-solving capabilities.

• Ability to convey warmth, openness, and calmness through phone communication.

• Capability to build trust quickly and engage members through a motivational approach.

• Flexibility in addressing diverse member needs and concerns during conversations.

• Strong computer proficiency, including MS Office Suite, Adobe Acrobat, and data processing.

• Skilled at data entry across multiple systems while simultaneously talking and typing.

• Must pass background checks upon hiring and throughout employment, including criminal, employment, education, sanctions, prohibited-party, sex-offender-registry, and 10-panel drug-screen checks.

• High-speed internet connection with a minimum download speed of 20 Mbps, upload speed of 5 Mbps, and maximum latency of 100 milliseconds.

• Ability to work from a designated home workspace that meets company standards.

• Must utilize a dual-monitor desktop setup with a hardwired internet connection.

• Must comply with a stationary workstation requirement.

🏝️ Benefits

• Quarterly performance-based discretionary incentive.

• Coverage for medical, dental, and vision.

• 401(k) plan with a competitive employer match.

• Company-funded life and disability insurance.

• Paid parental leave and wellbeing incentives.

• Generous paid time off, including time allocated for volunteering.

• Flexible spending accounts for healthcare and dependent care.

• Opportunities for professional development and tuition reimbursement.

• Flexibility for remote work.

• Equipment provided by the company.

• Potential for significant personal and professional growth.