Benefits Navigator, Bilingual Spanish

Labor First•Scottsdale, AZ

About The Position

The Benefits Navigator/Advocate is a high-touch, non-clinical healthcare navigation and member advocacy role. The Advocate works one-on-one with members, including employees, dependents, and early retirees, to help them understand their benefits, navigate the healthcare system, resolve issues, access appropriate resources, and reduce avoidable healthcare friction and cost. HealthActive combines human advocacy, proactive outreach, and data-informed next best actions to help members use healthcare more effectively. The Advocate supports members with empathy, clarity, and follow-through while helping drive engagement, improved outcomes, and measurable value for clients. LaborFirst is a care navigation and advocacy company serving group plan sponsors and their members. Its HealthActive solution supports self-insured health plans with one-on-one health advocacy and technology-driven insights. The role is bilingual in Spanish and English.

Requirements

At least 2 years of experience in healthcare customer service, member services, benefits navigation, care coordination, call center support, case management support, or a related healthcare support role.
Must be bilingual in Spanish.
Strong customer service, communication, and relationship-building skills.
Ability to explain complex healthcare and benefits information in simple, practical terms.
Strong problem-solving skills, sound judgment, organization, follow-through, and multitasking ability.
Empathy, patience, and professionalism when supporting members through stressful or confusing situations.
Comfort working in CRM, case management, or other technology platforms.
Ability to maintain confidentiality and follow HIPAA requirements.

Nice To Haves

Experience with employer-sponsored health plans, claims, networks, referrals, prior authorizations, denials, pharmacy benefits, or member advocacy.
Familiarity with medical terminology.
Experience conducting proactive member outreach.
Experience supporting members with chronic conditions, high-cost needs, or complex healthcare needs.
Familiarity with specialized benefit solutions, wellness programs, or care navigation resources.

Responsibilities

Serve as a trusted resource for members navigating healthcare questions, benefit concerns, provider access issues, and care-related barriers.
Help members understand and use medical, pharmacy, and applicable ancillary benefits.
Help members locate appropriate in-network providers, understand care options, prepare for provider conversations, and navigate referrals, authorizations, claims, denials, and billing issues.
Support access to second-opinion resources, specialized programs, and plan or vendor resources without providing clinical advice or making medical decisions.
Provide empathetic support in complex or stressful healthcare situations and appropriately escalate urgent, complex, or clinical matters.
Explain coverage, benefit design, network rules, out-of-pocket cost considerations, claims, and administrative processes in clear, member-friendly language.
Help members identify lower-cost, high-quality care options when available and appropriate, and guide them toward appropriate resources to avoid unnecessary, duplicative, or poorly coordinated care.
Identify when members may benefit from specialized solutions, including MSK, diabetes, behavioral health, pharmacy, wellness, second-opinion, or other client-sponsored programs, and route them appropriately.
Conduct proactive outreach based on program priorities, claims-informed cohorts, gaps in care, seasonal campaigns, and next-best-action opportunities.
Engage members to explain available benefits, programs, and resources, including outreach related to preventive care, chronic condition management, medication adherence, care gaps, high-cost claims patterns, and appropriate program use.
Help drive HealthActive program engagement, utilization, member satisfaction, and measurable value.
Document member interactions, outreach activity, issue resolution steps, referrals, and outcomes in the appropriate CRM or care platform; maintain accurate, timely, and complete case notes.
Protect member privacy, maintain HIPAA compliance, and follow approved communication protocols for phone, email, text, and other engagement channels.
Identify recurring member issues, access barriers, or process gaps and escalate trends to leadership as appropriate.