Care Navigator

Independent Health; Buffalo (NY); Hybrid; USD 25,000 - 30,000; Full time

Job summary

Independent Health in Williamsville, NY is seeking a Care Navigator to be the first contact for member and provider inquiries, providing high-touch assistance with benefits, scheduling, and resource identification. You will listen empathetically, resolve issues, and connect members to the right care resources.

This hybrid role requires strong communication, problem solving, and an ability to navigate a complex healthcare system while supporting members in maximizing their health coverage.

Qualifications

• High School Diploma or GED required.
• Six months of customer service experience required.
• Healthcare or social services setting preferred.
• Ability to navigate a complex healthcare system and educate members.

Responsibilities

• Serve as customer advocate by listening to understand needs.
• Navigate systems to locate information for inquiries (benefits, eligibility, billing, claims).
• Handle inquiries related to benefits, scheduling, appointments, and authorizations.
• Educate members and connect them to tools and resources to make informed decisions.
• Log all contacts and maintain compliance with policies.

Skills

Empathetic listening

Customer service

Communication skills

Problem solving

Multitasking

MS Office proficiency

Education

High School Diploma or GED

Tools

Microsoft Word

Microsoft Excel

Microsoft PowerPoint

ACT

Job description

FIND YOUR FUTURE

We're excited about the potential people bring to our organization. You can grow your career here while enjoying first-class perks, benefits and a culture that fosters growth, innovation and collaboration.

Overview

The Care Navigator is the first point of contact for all member and provider inquiries. The Care Navigator is a professional who displays confidence, a passion for health and wellness, and practices empathetic listening in every interaction. The Care Navigator provides high touch assistance to members in areas such as benefit questions, provider selection, health improvement, identification of care resources, and facilitation of benefit utilization, such as assisting members with appointment scheduling, and preparing for medical appointments. Care navigators find creative solutions to overcome member barriers. While some members follow the path of the typical healthcare consumer, others have unique needs that require initiative and creative thinking to locate the appropriate resource. Other duties may also include, closing gaps in care, assisting with appointment scheduling, and communicating with providers to deliver the best customer care experience we can.

Qualifications

• High School Diploma or GED required.
• Six (6) months of customer service experience required. Experience in a healthcare related or social services setting preferred.
• Desire to positively impact our members' health coverage experience through empathetic listening and high touch experience.
• Ability to build cohesive relationships, solve problems, and support our members by providing them resources and education that promote their ability to navigate a complex healthcare system.
• Must be adaptable and thrive in a high energy, creative, and evolving work environment.
• Ability to handle multiple duties with minimal direction and apply critical thinking skills and make decisions based upon individual needs.
• Excellent interpersonal, verbal and written communication skills.
• Microsoft Office proficient. Computer skills that include but are not limited to Word, Excel, Power Point and ACT.
• Proven examples of displaying Nova's Core 4: Act with Passion, Work Together, Be Accountable, Build Trust.

Essential Accountabilities

• Servicing
  • Responsible for acting as a customer advocate by demonstrating active listening skills to fully understand the scope of the customers' needs.
  • Efficiently navigate through systems and applications to locate information specific to the customer inquiry. These inquiries may include, but are not limited to:
    • Benefit, eligibility, provider billing and complex claim inquiries.
    • ID card requests.
    • PCP Assignment and provider searches.
    • Prior-authorization status and management.
    • Out-of-network redirection and negotiation awareness.
    • Case and disease management referrals.
    • Repatriation.
    • Member website, app and portal assistance.
    • Appointment scheduling.
    • Contractual and clinical appeals.
    • COB/Dependent verification.
    • Subrogation calls.
    • Interdepartmental call flow response standards
  • Ensure that our members/employers are obtaining accurate and up-to-date information on policies and procedures and communicate a successful resolution to inquiries.
  • Ensure compliance with all DOL rules and regulations.
  • Build trusting relationships with customers using an empathetic and compassionate approach.
  • Effectively solve problems utilizing critical thinking skills.
  • Accurately read, interpret, and apply appropriate information to each customer interaction.
  • Identify opportunities to educate customers by providing tools and resources to make informed decisions.
  • Meet or exceed all department standards in the following categories as measured and recorded in the representatives' scorecard.
  • Log all contacts into appropriate systems.
• Technical Proficiency
  • Maintain technical knowledge regarding benefit plan documents.
  • Attend all required training sessions.
  • Address first level complaints and aid with appeals as needed.
  • Effectively resolve inquiries from customers regarding claims, benefits, eligibility, and reimbursement.
  • Maintain knowledge of all pertinent systems and the ability to coordinate the use of these tools at the same time.
  • Working knowledge of Nova's policies and procedures to include departmental policies and procedures based on the line of business being served.
• Administrative Duties
  • Other duties as required by direct management which may include but may not be limited to servicing walk-in members, and correspondence support.
  • Mentor new Care Navigation associates.

This is a hybrid position with onsite attendance required at our Williamsville location.

Immigration or work visa sponsorship will not be provided for this position

Hiring Compensation Range: $20.00 hourly

Compensation may vary based on factors including but not limited to skills, education, location and experience.

In addition to base compensation, associates may be eligible for a scorecard incentive, full range of benefits and generous paid time off. The base salary range is subject to change and may be modified in the future.

As an Equal Opportunity / Aff ... Click here for additional EEO/AAP or Reasonable Accommodation information.

Current Associates must apply internally via the Job Hub.