Member Care Navigator
About The Position
The Member Care Navigator serves as the trusted main point of contact for members, guiding them through their healthcare journey with empathy, accuracy, and purpose. The role provides timely and precise information about healthcare benefits, documents interactions, and escalates inquiries or concerns to ensure a high level of service. The position is based at Frontier’s headquarters in Harlingen, Texas, and is full time. The successful candidate is optimistic, resilient, mission-driven, calm under pressure, and motivated to help others navigate complex systems while making each interaction positive and meaningful.
Requirements
- At least 3 years of experience in a healthcare setting, such as Medical Assistant, CNA, Concierge, Patient Navigator, or Case Manager.
- Experience with patient scheduling in a medical office, clinic, or health system.
- Working knowledge of medical terminology.
- Working knowledge of CPT/ICD-10 codes, healthcare procedures, and relevant regulations.
- Proficiency with EHR, EMR, or similar ERP systems.
- Ability to switch tasks and manage multiple digital tools and workflows simultaneously.
- Experience navigating multiple systems and complex workflows while meeting SLAs and other work-related metrics.
Nice To Haves
- Bilingual Spanish and English skills are strongly preferred.
- Call center or high-call-volume office experience.
- Experience handling inbound and outbound calls while adhering to specific call metrics.
- Experience with claims, prior authorizations, medical coding, or billing.
Responsibilities
- Answer inbound calls and serve as the main point of contact for member and provider questions, regardless of plan design.
- Respond to inquiries about claims, appeals, referrals, benefits, plan design, card usage, and Direct Pay casework.
- Manage assigned tasks proactively, including making outbound calls to members, providers, and insurance companies.
- Maintain assigned email inboxes and alerts to support timely responses and resolution.
- Meet or exceed performance metrics related to call coverage, attendance, and case management.
- Participate in quality improvement initiatives to enhance processes and member experiences.
- Attend ongoing training and leadership meetings to stay current with updates, system changes, and group requirements.
- Document member interactions and escalate inquiries or concerns as needed.
Benefits
- Medical insurance
- Dental insurance
- Vision insurance
- Frontier Membership for the employee and immediate family
- Voluntary short-term disability insurance
- Voluntary long-term disability insurance
- Life insurance and other supplemental insurance
- 401(k) plan
- Accrued paid time off, including up to 5 unplanned days off per year
- 9 additional company holidays
- Parental leave policies
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What This Job Offers
Job Type
Full-time
Education Level
No Education Listed
