- Location
- Remote
- Workplace
- Remote
- Type
- Full-time
- Department
- Healthcare
- Source
- Pinpoint
Description
Care Navigator
Department: Operations
Employment Type: Permanent - Full Time
Location: Remote
Description
🌎 About this Role:
- Being the warm, persistent point of contact a member can hand a confusing bill, denial, or complex question to
- Helping members navigate the appeals process when they don't know where to start, and reviewing complex cases as they come up
- Reviewing EOBs to catch any errors and advocating for the member
- Coordinating between a member and their providers to resolve billing and coverage issues end to end
- Helping members and providers understand what requires prior authorization and making sure it's submitted correctly and on time, including specialty and pharmacy pre-authorization
- Translating plan design and benefits into plain language so members understand what is and isn't covered
- Pointing members toward high-value, in-network care and providers - this is administrative navigation, not clinical advice
- Flagging patterns you notice in claims and costs to help us keep improving the plan
🧪 You are a good fit if you:
- Have several years in a medical-administrative or patient-facing coordination role
- Have hands-on experience with claims, medical billing, and pre-authorizations, and can read an EOB and spot when something's off
- Have working familiarity with CPT and ICD coding and how charges are built and submitted
- Are comfortable coordinating across members, providers, and payers, with the persistence to chase something to resolution
- Communicate warmly and clearly with members
- Extra shine if you have prior experience on the payer or claims-administration side of health insurance, hold a BCPA certification, or come from a clinical-adjacent background
- Want to help build a global social safety net on the Internet.
- Think for themselves instead of copying others.
- Are willing to try new things, even with the risk of failure.
- Are intellectually curious and open to new ideas.
- Are creative and bold in the face of any problems.
- Have strong integrity and do the right thing.
🧘 Benefits beyond base pay:
- Fully remote work environment – work from anywhere globally
- Our own global safety net, giving you worldwide health, income, and travel coverage
- A minimum of four weeks of vacation per year
- A new laptop when you need one
- Potential to unlock equity compensation, yearly home office allowance and more!