Member Care Navigator at Frontier Direct Care

Harlingen, Texas, United States -

Full Time

Start Date

Immediate

Expiry Date

23 Jun, 26

Salary

0.0

Posted On

25 Mar, 26

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Member Care Navigation, Healthcare Benefits Knowledge, Empathy, Accuracy, Inbound Calls, Outbound Calls, Claims Processing, Appeals Handling, Referrals Management, Benefit Information, Plan Design, Case Management, Electronic Health Records (EHR), Electronic Medical Records (EMR), Task-Switching, Bilingual (Spanish & English)

Industry

Hospitals and Health Care

Description

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! 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. This is a full time position based at our headquarters in Harlingen, TX. 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 Sound Like You? 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: Free access to financial wellness platforms that provide financial advisors + personal finance tools Time Off Enjoy our 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 Care, 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.

Responsibilities

The Member Care Navigator acts as the primary contact for members, providing accurate information regarding healthcare benefits, claims, referrals, and plan design while documenting all interactions. Responsibilities also include proactively managing assigned tasks, handling both inbound and outbound communications, and consistently meeting performance metrics.