Care Navigator

What you’ll do

• Serve as a warm, persistent point of contact for members with complex bills, denials, coverage questions, and other insurance issues.
• Guide members through appeals processes and review complex cases as they arise.
• Review explanations of benefits (EOBs), identify potential errors, and advocate for members.
• Coordinate with members, healthcare providers, and payers to resolve billing and coverage issues end to end.
• Explain prior-authorization requirements and help ensure medical, specialty, and pharmacy authorizations are complete and timely.
• Translate plan design and benefits into clear, practical language so members understand their coverage.
• Direct members to high-value, in-network care and providers; provide administrative navigation rather than clinical advice.
• Flag patterns in claims and costs to help improve the plan and member experience.

What you bring

• Several years of experience in a medical-administrative, patient-facing coordination, or care-navigation role.
• Hands-on experience with claims, medical billing, pre-authorizations, and reading EOBs.
• Working familiarity with CPT and ICD coding, charges, and claim submission processes.
• Experience coordinating across members, providers, and payers through to resolution.
• Clear, empathetic, and reliable written and verbal communication.
• Persistence, ownership, and sound judgment when managing sensitive, complex cases.

Nice to have

• Experience in health-insurance payer operations or claims administration.
• Board Certified Patient Advocate (BCPA) certification.
• A clinical-adjacent background.