Healthcare Benefits Navigator
Location: Scottsdale, AZ (On-Site)
Job Type: Full-Time, Non-Exempt
Schedule: Monday-Friday, 9:00 AM - 5:00 PM
Compensation: $47,840 - $54,080 annually
About the Opportunity
We are seeking an empathetic, solutions-oriented Healthcare Benefits Navigator to join our growing team. In this high-touch member advocacy role, you will work directly with actively employed professionals, commercial union members, and their dependents to help them navigate the complexities of employer-sponsored health plans.
This position goes beyond traditional customer service by emphasizing proactive outreach, healthcare advocacy, and personalized support. You will help members overcome barriers to care, understand their benefits, resolve insurance-related challenges, and access high-quality, cost-effective healthcare services.
This is an excellent opportunity for professionals with healthcare, insurance, hospital, or care coordination experience who are passionate about improving the member experience and making a meaningful impact on people's lives.
Key Responsibilities
Proactive Member Outreach
- Conduct outbound outreach campaigns based on data-driven insights to engage members needing support with preventive care, chronic condition management, and medication adherence.
- Identify care gaps and provide guidance to help members access appropriate healthcare services.
Healthcare Advocacy & Navigation
- Serve as a trusted resource for members and their families by helping them navigate medical, pharmacy, and ancillary benefits.
- Educate members on available healthcare resources and benefit options in a clear and understandable manner.
Claims, Billing & Authorization Support
- Assist members with locating in-network providers and facilities.
- Help troubleshoot prior authorizations, referrals, claim denials, billing disputes, and coverage questions.
- Advocate on behalf of members to resolve complex healthcare issues efficiently.
Commercial Health Plan Guidance
- Support members across a variety of employer-sponsored and self-funded health plans.
- Explain deductibles, copays, coinsurance, out-of-pocket expenses, and network requirements.
- Guide members toward cost-effective care options while maximizing available benefits.
Resource Coordination
- Connect eligible members with specialized programs and resources, including behavioral health, diabetes management, musculoskeletal care, and other employer-sponsored wellness initiatives.
- Ensure smooth transitions and follow-through when referring members to additional services.
Documentation & Compliance
- Maintain accurate and timely case documentation within internal CRM systems.
- Adhere to HIPAA regulations and organizational privacy standards.
- Track member interactions, outcomes, and case progress with exceptional attention to detail.
Qualifications
Required Qualifications
- 2+ years of experience in healthcare customer service, commercial insurance, health system navigation, hospital billing, medical office operations, care coordination, or a related healthcare setting.
- Strong understanding of employer-sponsored health plans, provider networks, healthcare terminology, and insurance processes.
- Excellent communication, active listening, and problem-solving skills.
- Ability to explain complex healthcare and insurance concepts in simple, actionable language.
- Proficiency with CRM platforms, healthcare software, and multi-system workflows.
- Strong organizational skills and attention to detail.
Preferred Qualifications
- Experience conducting proactive outbound member or patient outreach.
- Background supporting commercial health insurance plans, self-funded employer groups, or labor union populations.
- Experience assisting individuals with high-cost claims, chronic conditions, or complex healthcare needs.
- Previous healthcare advocacy or patient navigation experience.
What We Offer
- Competitive compensation
- Comprehensive benefits package
- 401(k) with company contribution
- Generous paid time off
- Structured onboarding and comprehensive training program
- Career advancement and professional growth opportunities
- Opportunity to join one of New Jersey's fastest-growing companies
- Collaborative and mission-driven team environment
Additional Information
- Immediate opening available
- Additional hiring planned throughout the year as the organization continues to expand
- Comprehensive multi-week training provided to ensure success and mastery of various health plan offerings
If you are passionate about helping people navigate the healthcare system and thrive in a member-focused environment, we encourage you to apply.