Insurance Navigator

Triumph Treatment Services

7d•Hybrid

About The Position

Help individuals access the healthcare they need by guiding them through insurance enrollment, renewals, and coverage options with clarity and compassion. As an Insurance Navigator, you play a critical role in removing barriers to care while ensuring accuracy, compliance, and continuous coverage for those we serve. The Insurance Navigator assists persons served in accessing and maintaining health insurance coverage, with a focus on Washington Apple Health (Medicaid) and Washington Healthplanfinder programs. This role provides fair, accurate, and impartial enrollment assistance, eligibility screening, and benefits education while collaborating with internal teams and external partners to prevent coverage gaps. The position requires Washington State–mandated Navigator certification and ongoing training to ensure compliance with privacy, enrollment, and consumer assistance standards.

Requirements

High school diploma or equivalent required
Must complete initial Navigator certification training through the Washington Health Benefit Exchange (WAHBE) Learning Management System (LMS) prior to providing enrollment assistance.
Must successfully complete all required annual and quarterly recertification trainings to maintain active Navigator status and system access.
Must comply with WAHBE training timelines; failure to complete required trainings may result in suspension of Healthplanfinder access and inability to perform essential job functions.
Must remain in good standing with the organization’s designated Navigator Lead Organization and follow all Exchange policies regarding privacy, impartiality, and consumer assistance.
Experience in health insurance, case management, or healthcare navigation preferred.
Strong knowledge of Medicaid, Medicare, and ACA Marketplace programs.
Excellent communication, interpersonal, and problem-solving skills.
Ability to work independently and as part of a team.
Proficient in Microsoft Office Suite and database management.
Valid drivers license and insurance
Ability to understand, remember, and apply oral and written instructions or other instructions.
Ability to plan, organize, and carry out assignments from management staff with minimal direction.
Ability to analyze situations and make decisions that moderately impact the immediate work unit.
Ability to organize and prioritize job duties effectively and timely, set priorities, and meet critical deadlines.
Ability to understand and follow basic instructions and guidelines, complete routine forms, and communicate orally.
Hearing, seeing, smelling, speaking, feeling, reaching, pinching, and repetitive motions.
Standing, walking, and bending for long periods.
May require exerting up to 40 pounds of force to lift, carry, pull, or move objects.

Nice To Haves

Associate’s or Bachelor’s degree in health administration, social work, or related field preferred.
Bilingual skills a plus

Responsibilities

Conduct eligibility screenings to determine appropriate insurance options for persons served.
Assist persons served in understanding and enrolling in Washington Apple Health (Medicaid), Washington Healthplanfinder Qualified Health Plans, and other applicable coverage programs, including renewals and redeterminations.
Help persons served complete applications, renewals, and required documentation for insurance enrollment.
Verify insurance eligibility, benefits, and managed care enrollment prior to service initiation.
Provide education to persons served regarding insurance benefits, cost-sharing responsibilities, and covered services.
Serve as a liaison between persons served and managed care organizations to resolve coverage issues or disputes.
Monitor renewal and redetermination dates and proactively prevent coverage lapses.
Maintain accurate records of interactions, enrollment status, and follow-up activities.
Safeguard protected health information in compliance with HIPAA and 42 CFR Part 2.
Complete all Exchange-mandated continuing education and quarterly training updates related to Washington Healthplanfinder, Apple Health (Medicaid), Qualified Health Plans, and special enrollment policies.
Collaborate with healthcare providers, managed care organizations, community partners, and social service agencies, and participate in outreach efforts to improve insurance access, enrollment continuity, and support the needs of persons served.
Provide fair, accurate, and impartial information regarding health coverage options; does not sell insurance, receive compensation from insurers, or provide legal or tax advice.
Enter and maintain consumer information in Washington Healthplanfinder in compliance with Exchange security, confidentiality, and access standards, including periodic required logins to maintain account access.