Member Care Coordinator

🔥 5 minutes ago

🇺🇸 United States – Remote

💵 $20 - $22 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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Calibrate

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2020

🏥 Healthcare

🍽️ Food & Beverage

💼 Consulting

Healthcare • Food & Beverage • Consulting

Calibrate is a health and wellness company that specializes in sustainable weight loss through a metabolic approach. Members of Calibrate experience an average weight loss of 19% over three years, leveraging clinician-prescribed medications and personalized video coaching. The program is designed to improve metabolic health, reduce inflammation, and support lifestyle changes that lead to long-term weight management. Guided by scientific research, Calibrate emphasizes a holistic method that includes nutrition, exercise, sleep, and emotional health to foster sustainable behavior change.

📋 Description

• Execute critical clinical administrative workflows to resolve readiness barriers and accelerate members toward provider review and medication access • Prepare clinical documents and proactively triage member needs for specialty support • Facilitate structured handoffs of critical information to Clinical and Coaching teams • Participate in cross-functional meetings and collaborate with other departments to improve member care • Identify and report recurring systemic issues, submission errors, and operational trends • Own the end-to-end medication access workflow, including gathering clinical data, coordinating with clinicians, submitting complex prior authorizations, investigating denials, documenting appeals, and managing final determinations and overrides • Contact members by phone and secure message to request information and explain complex prior authorization status changes or delays • Call insurance carriers, PBMs, and pharmacies to obtain case statuses, track documentation, and secure approvals • Log communications, investigation notes, and prior authorization statuses accurately in case management systems such as Zendesk and MJD • Resolve pharmacy-level rejections and troubleshoot insurance issues preventing successful claims processing

🎯 Requirements

• Completion of a formal medical assisting program is highly valued • National certification such as Certified Medical Assistant (CMA) awarded by the AAMA or Registered Medical Assistant (RMA) awarded by the AMT is preferred • Familiarity with case management systems such as Zendesk, Electronic Health Records (EHR), and PA/e-prescribing platforms is highly desirable • 2+ years of high-volume customer service, call center, or patient advocacy experience, preferably in a healthcare, pharmacy, or PBM setting • Demonstrated experience managing complex, multi-step processes requiring follow-up and persistence • Exceptional verbal and written communication skills • Ability to handle challenging, escalated calls and messages with professionalism and empathy

🏖️ Benefits

• Generous paid time off policy, including multiple paid company holidays, wellness days, and floating holidays • Medical, dental, and vision benefit options • Calibrate-funded disability and basic life insurance • Wellness programs, including a complimentary Headspace membership and therapy through Headspace Care • Employee Assistance Program through Principal • Remote-first ways of working, with flexibility to work from any state • Competitive paid parental leave program

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