Position Summary

The Healthcare Benefits Navigator serves as a trusted resource and educator for members seeking assistance with healthcare benefits, enrollment support, healthcare navigation, pharmacy benefits, and issue resolution. This role provides education and guidance while delivering a high-touch member experience.

This is a non-licensed position. Team members provide education, navigation, and support but do not provide licensed insurance advice. Activities requiring licensure are escalated to licensed professionals.

Essential Responsibilities

Benefits Education & Guidance

Explain health plan options and benefit structures.
Educate members regarding deductibles, copays, coinsurance, provider networks, and coverage options.
Support member understanding of ICHRA and employer-sponsored healthcare benefits.
Help members make informed healthcare decisions through education and guidance.
Enrollment Support

Guide members through enrollment activities.
Assist with applications and required documentation.
Verify information and assist in resolving enrollment-related concerns.
Monitor enrollment progress and conduct follow-up activities as needed.
Healthcare Navigation

Answer healthcare benefit and coverage questions.
Assist members in locating providers, specialists, pharmacies, and healthcare resources.
Support understanding of pharmacy benefits and medication access.
Member Outreach

Conduct outbound outreach activities during Open Enrollment and throughout the year.
Follow up with eligible members who have not completed enrollment.
Provide reminders regarding required actions and deadlines.
Re-engage members who discontinue enrollment activities.
Documentation & Case Management

Document member interactions and next steps.
Maintain accurate case notes and records.
Identify member barriers, concerns, and trends.
Support quality assurance and reporting initiatives.
Required Qualifications

High School Diploma or GED.
Minimum one (1) year of experience in healthcare customer service, health insurance, PBM member services, Medicare support, benefits administration, healthcare call center operations, or a related field.
Strong verbal and written communication skills.
Ability to simplify complex healthcare concepts for consumers.
Strong documentation and organizational skills.
Ability to efficiently navigate multiple computer applications simultaneously.
Ability to work independently in a remote environment.
Preferred Qualifications

PBM Member Services experience.
Health Plan Member Services experience.
Benefits enrollment experience.
Medicare support experience.
ICHRA, HRA, TPA, or benefits administration experience.
Healthcare advocacy or patient navigation experience.