Member Care Navigator

Frontier Direct, LLC; Harlingen (TX); On-site; USD 42,000 - 66,000; Full time

Benefits offered by this job

Medical, dental, and vision insurance

Frontier Membership for you and your 1

Voluntary insurance: short-term/long‑/

401(k) plan

Job summary

Frontier Direct, LLC is seeking a Member Care Navigator at our Harlingen, TX headquarters for a full-time role. You will guide members through their healthcare journey with empathy and accuracy, providing info on benefits and ensuring high-quality service.

The role requires Spanish/English bilingual ability, healthcare experience, proficiency with EHR/EMR systems, and strong multi-system navigation to meet SLA and performance metrics.

Qualifications

• Bilingual (Spanish & English) required or strongly preferred.
• Minimum 3 years of experience in a healthcare setting (Medical Assistant, CNA, Concierge, Patient Navigator, Case Manager, or similar).
• Experience with patient scheduling in medical offices, clinics, or health systems.
• Experience in call center or high call volume environments.
• Familiarity with CPT/ICD-10 codes and healthcare procedures.

Responsibilities

• Answer inbound calls and serve as the main point of contact for member and provider questions.
• Respond to inquiries related to claims, appeals, referrals, benefits, and plan design.
• Proactively manage tasks including outbound calls to members, providers, insurers, etc.
• Maintain assigned email inboxes and alerts to ensure timely responses.
• Meet or exceed performance metrics related to call coverage and case management.
• Participate in quality improvement initiatives to enhance processes and experiences.
• Engage in ongoing training and leadership meetings.

Skills

Bilingual (Spanish & English)

Healthcare experience

Medical terminology

EHR/EMR proficiency

Call center / high volume

Patient scheduling

CPT/ICD-10 knowledge

Multi-system navigation

Tools

EHR/EMR systems

Job description

At Frontier, we are transforming healthcare. Our patients get access to the care they need quickly and efficiently while experiencing improved health outcomes for the first time in their life. Join us in shaping the future of healthcare!

TRANSFORM HEALTHCARE AND CREATE MASSIVE IMPACT

We build experiences people love by incorporating empathy, care and trust. We challenge the status quo to restore the patient-provider relationship, starting with a team that deeply cares about healthcare and each other.

This is a full time position based at our headquarters in Harlingen, TX.

The Member Care Navigator serves as the trusted main point of contact for our members, guiding them through every step of their healthcare journey with empathy, accuracy, and a sense of purpose. You’ll provide timely and precise information about healthcare benefits, document all interactions, and elevate inquiries or concerns as needed to ensure the highest level of service.

A successful Member Care Navigator is optimistic, resilient, and mission-driven. You approach challenges with grit and empathy, staying calm under pressure and motivated by the purpose behind your work. You find fulfillment in helping others navigate complex systems, always striving to make each interaction a positive and meaningful experience.

What You’ll Be Doing

• Answer inbound calls and serve as the main point of contact for all member and provider questions, regardless of plan design.
• Respond to inquiries related to claims, appeals, referrals, benefit information, plan design, card usage, and Direct Pay casework.
• Proactively manage assigned tasks, which will include making outbound calls to members, providers, insurance companies etc.
• Diligently maintain assigned email inboxes and alerts to ensure timely response and resolution.
• Consistently meet or exceed performance metrics related to call coverage, attendance, and case management.
• Participate in quality improvement initiatives to enhance processes and member experiences.
• Engage in ongoing training and leadership meetings to remain current with all updates, system changes, and group requirements.

Requirements

• Bilingual (Spanish & English) strongly preferred.
• Minimum 3 years of experience in a healthcare setting (including Medical Assistant, CNA, Concierge, Patient Navigator, Case Manager, or other similar roles).
• Experience with patient scheduling (medical office, clinic or health system)
• Call center or high call volume office experience preferred.
• Experience handling both inbound and outbound calls, adhering to specific call metrics
• Working knowledge of Medical terminology
• Working knowledge of CPT/ICD-10 codes, healthcare procedures, and relevant regulations.
• Claims, prior authorizations, medical coding/billing experience preferred
• Demonstrated proficiency with Electronic Health Records (EHR) Electronic Medical Records (EMR) or similar Enterprise Resource Planning (ERP) systems, required.
• Experienced in task-switching and comfortable managing multiple digital tools and workflows simultaneously.
• Demonstrated experience navigating multiple systems and complex workflows while meeting SLAs and other work related metrics.

BENEFITS

Taking Care of You Now and Your Future

• Medical, dental, and vision insurance
• Frontier Membership for you and your immediate family
• Voluntary insurance: short-term disability, long-term disability, life insurance, and other supplemental insurances
• 401(k) plan

Time Off

• Enjoy our Accrued Paid Time Off (PTO) policy. Within this benefit, we include up to 5 unplanned days off per year
• 9 additional company holidays
• Parental leave policies

At Frontier Direct, we value diversity. We are an equal opportunity employer: we do not discriminate on the basis of race, religion, color, national origin, gender, sexual orientation, age, marital status, veteran status, or disability status.