Regional Concierge Navigator (Bilingual in Spanish)
Core
Provides in-market, specialized member support and outreach to seniors and chronically ill individuals, ensuring access to care and navigating health plan operations.
Role type
Regional Concierge Navigator (Member Services)
Builds
Coordinated care journeys for Medicare Advantage/HMO members
Domain
Health insurance / Senior care
Deliverable
client delivery
Required skills
Medicare Advantage/HMO navigation, ICD-10 and CPT codes knowledge, authorizations and referrals processing, provider appointment scheduling, medical records retrieval, eligibility and benefits verification, high-volume inbound customer service, bilingual communication (English/Spanish)
Preferred skills
Telemarketing experience, member outreach experience, escalation resolution experience, high-volume health plan member services background
Technologies
CRM systems, telephony platforms, electronic health record interfaces
Responsibilities
Conduct in-market member engagement including welcome calls and onboarding; resolve member issues and conduct case follow-ups; coordinate care by ensuring access to PCPs and specialists; educate members on care gaps and schedule appointments; serve as patient liaison for program quality measures; handle incoming calls regarding eligibility, benefits, and clinical needs; place regular outreaches to patients; participate in on-site member engagement activities as needed.
Seniority
Entry-level to Individual Contributor