Member Care Navigator

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🎰 Nevada, New Mexico, +2 more states – Remote

🎰 Nevada – Remote 🌶️ New Mexico – Remote 🌪️ Oklahoma – Remote 🤠 Texas – Remote

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 Ghost score 12%

What it means: how likely this posting is sitting open without active hiring.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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The OccuNet Company

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 1998

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

The OccuNet Company is a privately owned healthcare services firm focused on improving healthcare affordability and member experience through integrated, transparent solutions. It offers services including out-of-network negotiation, reference-based pricing, bill review, medical contract negotiations, and pharmacy benefit management, supported by its OnPoint technology platform and member advocacy teams. The company serves employers, payers, TPAs, health plans, brokers, and providers, emphasizing cost-efficiency, compassionate member support, and tech-enabled administration.

📋 Description

• Answer incoming calls and support members in scheduling appointments and accessing appropriate care. • Maintain continuous communication between members and providers. • Research accepting physicians or facilities based on plan design, member needs, and access barriers. • Partner 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, including timely follow-up, documentation, and clear next steps. • Make outbound calls to providers, clients, and partners to gather information, educate stakeholders, and provide updates. • Deliver a high-empathy, member-first experience and help members navigate benefits. • Explain open-network plans, reference-based pricing, and member benefits in simple language. • Liaise with providers regarding plan details, payment processes, and network structure. • Identify accepting or RBP-friendly facilities and provide alternatives. • Coordinate Single Case Agreements or escalations according to internal criteria. • Investigate and overcome delays or barriers threatening timely care. • Follow workflows, boundaries, and escalation protocols. • Use OnPoint, PON, and provider lookup systems to verify provider options. • Prioritize inquiries based on urgency, member risk, and available details. • Collaborate across departments to establish barrier-removing processes. • Attend training and team meetings to stay current on workflows, tools, and plan updates.

🎯 Requirements

• High school diploma or equivalent required. • Foundational understanding of medical cost containment products (RBP, out-of-network, access coordination). • Knowledge of CPT codes, claims forms, or general medical insurance preferred. • Experience in healthcare navigation, patient access, medical office operations, insurance verification, case management, or high-emotion customer service environments strongly preferred. • Exceptional verbal and written communication skills. • Empathy, emotional resilience, and the ability to stay calm under pressure. • Strong judgment 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. • Bilingual (Spanish) preferred. • Ability to uphold HIPAA and Department of Labor compliance standards. • Ability to maintain confidentiality of sensitive information. • Understanding of key clinical terms, service types, pre-authorization processes, diagnosis implications, and provider requirements without crossing clinical boundaries.

🏖️ Benefits

• 401(k) with matching • Dental insurance • Health insurance • Vision insurance • Health savings account • Paid time off • High-growth environment with clear opportunities for career growth • Welcoming atmosphere and culture