Member Care Navigator

Frontier Direct Care; Harlingen (TX); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Medical insurance

Dental insurance

Vision insurance

Frontier Membership

401(k) plan

Job summary

Frontier Direct Care in Harlingen, TX is seeking a proactive Member Care Navigator to guide members through their healthcare journey with empathy and accuracy. You will be the main contact for questions about benefits, claims, referrals, and plan design, ensuring timely responses and precise information.

You’ll handle inbound and outbound calls, maintain email inboxes, and collaborate across teams to meet SLAs while improving the member experience.

Qualifications

• Bilingual Spanish & English preferred.
• Minimum 3 years of healthcare experience (MA, CNA, Concierge, Patient Navigator, Case Manager, or similar).
• Experience with patient scheduling (medical office, clinic or health system).
• Call center or high call volume office experience preferred.
• Experience handling inbound and outbound calls with SLA adherence.
• Knowledge of medical terminology.
• Knowledge of CPT/ICD-10 codes and healthcare procedures.
• Experience with claims, prior authorizations, coding/billing preferred.
• Proficient with EHR/EMR systems.

Responsibilities

• Answer inbound calls as the main contact for member and provider questions.
• Respond to inquiries about claims, appeals, referrals, benefit information, plan design, card usage, and Direct Pay casework.
• Proactively manage tasks including outbound calls to members, providers, insurers.
• Maintain email inboxes and alerts for timely responses.
• Meet or exceed performance metrics related to call coverage and case management.
• Participate in quality improvements to enhance processes and experiences.
• Engage in training and leadership meetings to stay updated.

Skills

Bilingual Spanish/English

Healthcare experience

Patient scheduling

Call center experience

EHR/EMR systems

Medical terminology

CPT/ICD-10 codes

Multi-tasking

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 escalated 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.