Care Navigator
Core
Support members on a US health insurance plan by helping them understand benefits, navigate claims/appeals, and coordinate care.
Role type
Care Navigator (Health Insurance Member Services)
Builds
US health insurance plan for remote workers
Domain
Health Insurance / Member Services
Deliverable
client delivery
Required skills
Claims administration, Medical billing, Pre-authorization management, EOB review, CPT/ICD coding familiarity, Provider coordination, Plan design interpretation
Preferred skills
Payer-side health insurance experience, BCPA certification, Clinical-adjacent background
Responsibilities
Serve as the primary point of contact for members with billing or coverage issues, Guide members through the appeals process, Review EOBs to identify errors and advocate for members, Coordinate between members and providers to resolve billing disputes, Manage prior authorizations for specialty and pharmacy services, Translate plan benefits into plain language, Identify patterns in claims and costs to improve the plan