Member Care Navigator

As the Member Care Navigator, you will provide members with exceptional support by delivering high quality, professional, and efficient service. You will also liaise with members and providers to assist in the coordination of
care related to medical access complexities.
 Answer incoming calls and support members in scheduling appointments and accessing appropriate care.
 Maintain open, continuous communication between members and providers.
 Research accepting physicians or facilities based on plan design, member needs, and access barriers.
 Partner closely with Account Management, Contracting, Advocacy, Pre-Neg, and TPA teams to resolve access
issues.
 Own the end-to-end member experience—from intake through resolution ensuring timely follow up,
documentation, and clear next steps.
 Make outbound calls to providers, clients, and partners to gather information, educate stakeholders, and provide
updates.
 Attend training and team meetings to stay current on workflows, tools, and plan updates.

Member Advocacy & Support
 Deliver a high-empathy, member-first experience in every interaction.
 Acknowledge frustration, build trust, and help members confidently navigate their benefits.
 Explain open-network plans, reference-based pricing, and member benefits in simple, jargon-free language.
 Own each case through resolution with proactive updates and follow-through.
 Document all interactions thoroughly and accurately to ensure continuity of care, compliance, and quality.
Provider Communication & Problem Solving
 Liaise professionally with providers to clarify plan details, payment processes, and network structure.
 Navigate provider pushback with calm, respectful communication.
 Identify accepting or RBP-friendly facilities and provide alternative options when needed.
 Coordinate Single Case Agreements (SCAs) or escalations based on internal criteria.
 Investigate delays or barriers that threaten timely care and act decisively to overcome them.
Operational Excellence
 Follow established workflows, boundaries, and escalation protocols with precision.
 Use internal research tools (OnPoint, PON, provider lookup systems) to verify provider options.
 Prioritize inquiries based on urgency, member risk, and available details.
 Collaborate across departments to establish processes that remove barriers to care.
 Uphold compliance standards, including HIPAA and Department of Labor guidelines.
 Maintain confidentiality of all sensitive information.
Clinical & Benefit Literacy
 Understand key clinical terms, service types, and the implications of delays in care.
 Confidently communicate around pre-authorization processes, diagnosis implications, and provider
requirements—without crossing clinical boundaries.
 Recognize scenarios requiring escalation due to potential impact on timelines or safety.

We are a company committed to creating diverse and inclusive environments where people can bring their full, authentic selves to work every day. We are an equal opportunity/affirmative action employer that believes everyone matters. Qualified candidates will receive consideration for employment regardless of their race, color, ethnicity, religion, sex (including pregnancy), sexual orientation, gender identity and expression, marital status, national origin, ancestry, genetic factors, age, disability, protected veteran status, military or uniformed service member status, or any other status or characteristic protected by applicable laws, regulations, and ordinances. If you need assistance and/or a reasonable accommodation due to a disability during the application or recruiting process, please send a request to HR@insightglobal.com.To learn more about how we collect, keep, and process your private information, please review Insight Global's Workforce Privacy Policy: https://insightglobal.com/workforce-privacy-policy/.

High school diploma or higher education
Foundational understanding of medical cost containment products (RBP, out of network, access coordination)
Exceptional verbal and written communication skills
Empathy, emotional resilience, and ability to stay calm under pressure
Strong judgement and ability to navigate sensitive or ambiguous situations
Persistent, detail-oriented, and committed to accurate documentation
Ability to manage multiple tasks simultaneously and adapt to frequent changes
Skilled in problem solving and anticipating member needs

Knowledge of CPT codes, claims forms, or general medical insurance
Experience in healthcare navigation, patient access, medical office operations, insurance verification, case management, or high emotion customer service environments
Spanish speaking

Benefit packages for this role will start on the 1st day of employment and include medical, dental, and vision insurance, as well as HSA, FSA, and DCFSA account options, and 401k retirement account access with employer matching. Employees in this role are also entitled to paid sick leave and/or other paid time off as provided by applicable law.