Member Navigator

Vālenz Health® is the destination for employers, brokers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience. Through advanced technology and clinical expertise, Valenz creates a distinctly different approach to a complex healthcare system. With our solutions, we execute across the entire healthcare journey — from member experience to payment integrity, provider quality, and plan performance.  With one of America’s largest cost, quality and utilization datasets, we create greater transparency, flexibility, and cost containment — empowering members and employers with the information they need to make smarter, more cost-effective decisions.

About This Opportunity:
As a Member Navigator, you’ll serve as a primary non-clinical point of contact for members, providing end-to-end support across assigned healthcare programs and services. You’ll help members navigate their experience by answering questions, explaining program benefits and processes, gathering and verifying required information, researching and resolving routine issues, coordinating appointments and services, and ensuring timely follow-up through resolution. You’ll collaborate with members, providers, clients, clinical teams, and internal business partners to facilitate timely access to care and deliver a seamless member experience. You’ll also maintain accurate case documentation, identify and address barriers, escalate complex or clinical matters to the appropriate resources, and provide support across programs and workflows as business needs evolve.

Things You’ll Do Here:

• Serve as a primary point of contact for members through phone, email, and other communication channels, providing timely, professional, and compassionate assistance.
• Educate members regarding applicable programs, benefits, processes, eligibility requirements, available services, provider options, and next steps.
• Gather, verify, and accurately document demographic information, eligibility information, benefit information, referrals, service needs, and other information required to support the member's case.
• Research member, provider, or client questions using available systems, resources, and established program guidelines; resolve routine issues independently and escalate complex, clinical, or non-standard matters appropriately.
• Coordinate the end-to-end scheduling process for imaging and other applicable healthcare services, including identifying appropriate providers, facilitating appointments, confirming scheduling details, and communicating updates to members and providers.
• Coordinate with Case Management, clinical staff, or other internal teams when a member requires clinical review, surgical support, additional care coordination, or services outside the Navigator's non-clinical scope.
• Manage assigned member cases through appropriate resolution, including monitoring progress, conducting follow-up, identifying barriers to service, and coordinating next steps with the appropriate stakeholders.
• Maintain complete and accurate documentation of member interactions, case activity, scheduling information, outcomes, and follow-up requirements in applicable CRM, scheduling, case management, and other departmental systems.
• Facilitate effective communication among members, providers, clients, clinical teams, and internal departments to support timely service delivery and a positive member experience.
• Build and maintain productive working relationships with provider facilities and other external partners.
• Identify service issues, potential escalations, or barriers to timely care and take appropriate action within established procedures to support resolution.
• Assist with claims-related, administrative, and operational activities associated with member cases as needed.
• Meet established quality, productivity, service level, documentation, and member experience expectations.
• Maintain working knowledge of assigned programs, processes, systems, and business initiatives and successfully cross-train across supported workflows.
• Flex between programs, queues, and work types based on volume and business needs.
• Collaborate with team members and cross-functional partners to identify opportunities to improve workflows, operational efficiency, and the member experience.
• Perform other duties as assigned.

• 2+ years of experience working in a remote, call center environment.
• High-school diploma or GED.
• Experience in healthcare scheduling, patient/member access, healthcare operations, customer service, insurance, medical office operations, or another related support environment.
• High attention to detail while maintaining courteous, accurate, and timely relations with our partners and members.
• Experience working independently and completing assignments within given instructions, routines, and accepted practices.
• Experience in a customer service focused and deadline driven environment.
• Excellent verbal and written communication skills.
• Experience with Microsoft Office Suite to include Excel and PowerPoint.
• Experience communicating complex information effectively.

• Associate’s degree
• Background in healthcare combined with medical, claims, or collection call center experience.
• Medical Terminology Certification
• Experience reading, interpreting, and explaining Explanation of Benefits (EOBs).
• BCPA Certification.

Where You’ll Work: This is a fully remote position, and we’ll provide all the necessary equipment!

• Work Environment: You’ll need a quiet workspace that is free from distractions.
• Technology: Reliable internet connection—if you can use streaming services, you’re good to go!
• Security: Adherence to company security protocols, including the use of VPNs, secure passwords, and company-approved devices/software.
• Location: You must be US based, in a location where you can work effectively and comply with company policies such as HIPAA.

Why You'll Love Working Here

Our mission is to advance healthcare through technology and expertise to optimize cost, quality, access, and utilization for all. We bring that mission to life through our commitment to Collaboration, Performance, Transparency, and Trust—the core values that guide how we work with our members, our customers, and each other.
 

Benefits

• Generously subsidized company-sponsored Medical, Dental, and Vision insurance, with access to services through our own products, Healthcare Blue Book and KISx Card.
• Spending account options: HSA, FSA, and DCFSA
• 401K with company match and immediate vesting
• Flexible working environment
• Generous Paid Time Off to include vacation, sick leave, and paid holidays
• Employee Assistance Program that includes professional counseling, referrals, and additional services
• Paid maternity and paternity leave
• Pet insurance
• Employee discounts on phone plans, car rentals and computers
• Community giveback opportunities, including paid time off for philanthropic endeavors

At Valenz, we celebrate, support, and thrive on inclusion, for the benefit of our associates, our partners, and our products. Valenz is committed to the principle of equal employment opportunity for all associates and to providing associates with a work environment free of discrimination and harassment. All employment decisions at Valenz are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social, or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV Status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate. We will not tolerate discrimination or harassment based on any of these characteristics.