Health Navigator I
Core
Provides phone, email, and chat-based customer service to members of specific health insurance groups by analyzing needs and providing timely, accurate responses regarding benefits and health programs.
Role type
Health Navigator I (Customer Service Representative)
Builds
Member support and resolution for Moda Health's Performance Guarantee and Moda 360 groups
Domain
Health Insurance / Member Services
Deliverable
client delivery
Required skills
Medical/dental/pharmacy terminology, diagnosis and procedure coding, 10-key proficiency (105 kpm), typing (25 wpm), claim processing, benefit analysis, provider search, eligibility confirmation
Preferred skills
Claim processing experience, prior customer service experience, medical/dental office or pharmacy background, knowledge of TriZetto Facets
Technologies
Moda 360 Navigator Console, Facets, Benefit Tracker, Content Manager, eviCore portal, Navitus, CoverMyMeds, Microsoft Office (Outlook, OneNote, Teams)
Responsibilities
Answer medical, dental, and/or pharmacy claim, authorization, and benefit questions; handle inquiries via phone, email, voicemail, and online chat; complete detailed research and follow-up to resolve member issues; use the Navigator Console to recommend health actions and programs; apply mathematical skills to determine correct benefit and claim information; advocate on behalf of members regarding covered care or medications; address and explain complaints, appeals, and grievances; update primary care physician selections and enter provider searches.
Seniority
Entry-level / Individual Contributor