Member Care Navigator

Frontier Direct Care • Harlingen, TX

2d • Onsite

About The Position

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 escalate 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.

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.

Responsibilities

• 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.

Benefits

• 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: Free access to financial wellness platforms that provide financial advisors + personal finance tools
• 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

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed