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Benefits Navigation Specialist

2 months ago

Tulsa, United States Medefy Health LLC Full time $15
Job DescriptionJob Description

Job Summary:

A Medefy Benefits Navigation Specialist (BNS) is responsible for assisting with the administration, navigation, and explanation of

company benefit plans serviced by Medefy. Benefits Navigation Specialists will educate plan members, using email, phone, or the

chat app, on their specific benefits plans, answer benefits/claims/pharmacy/healthcare questions and lead users to low-cost, high quality doctors and facilities in a friendly and time‐sensitive manner all through live chat via the Medefy platform. The goal of the

Benefits Navigator is to use their skill, knowledge, and friendly attitude to assist plan members through a successful and pleasant

benefits/healthcare journey. 

About our awesome company, Medefy Health...

Medefy Health (www.Medefy.com) is a healthcare benefits navigation SaaS company headquartered in Tulsa, OK. We’re

proud to be Oklahoma’s #1 fastest-growing company and rated by Inc. Magazine as the 37th fastest-growing tech company

and the 288th fastest-growing company overall in the USA…and our story is still being written

Healthcare is only getting more complicated, and more expensive, for employers and their employees. This is where Medefy

Health comes in. We’re on a mission to eliminate the stress on hard-working families caused by an impossible to navigate

healthcare system. All while saving them, and their employers, a significant amount of time and money. We demolish

barriers between healthcare and the people who need it, and we need your help to further our mission

Job Duties & Responsibilities:

• Monitor and respond to incoming user inquiries via email, phone, or the chat app in a friendly, timely (2 minutes

or less), and HIPAA‐compliant manner via computer-based applications or phone systems

• Answer users’ benefits questions, health insurance questions, coverage questions, and other related inquiries via

email, phone or the chat feature on the Medefy app

• Assists members with benefits claim issues and plan changes

• Act as a direct point of contact for members and providers, assisting them with medical and pharmacy benefit

information, prior authorization requests, and navigation support. You'll handle inquiries through various

channels, such as chat, fax, email, and written correspondence

• Address inquiries from members, human resources departments, pharmacies, and providers regarding mail order

services, benefit design, formulary coverage, medication costs, prior authorization criteria, and claims

adjudication. You'll ensure that individuals' questions and concerns are resolved

• Contribute to meeting operational and productivity standards, which may involve conducting quality reviews of

member interactions, and documentation to identify opportunities for improvement

• Stay familiarized with the details of Medefy client company health plans, third party vendors, health insurance,

benefits details, and other relevant items necessary to facilitate user solutions, including client health plan

changes, amendments, and alterations 

• Stays familiarized with Medefy software platform tools, HIPAA, and office policies 

• Work hand‐in‐hand with other Medefy departments to help users successfully complete their health care

journey 

• Follow‐up with users to ensure they had a pleasant encounter and successful outcome 

• Provide above and beyond service and professional

• Create referrals for the Referral Coordinators to process

• Performs other related duties as assigned

job description

You must have at least the following:

• Preferred associate's or bachelor's degree.

• Preferred 1-2 years of experience as a pharmacy technician in a PBM, pharmacy department of a health plan, or a

similar managed care setting. Alternatively, have 1-2 years of experience working in a mail order or specialty

pharmacy or with medical or pharmacy claims processing.

• Preferred an active Certified Pharmacy Technician (CPhT) certification.

• Detail-oriented, adaptable, critical thinker, empathetic, and able to delve deep into understanding issues to

identify root causes and resolutions. You have a genuine desire to enhance patients' healthcare experiences and

provide a high level of service.

• Familiarity with pharmacy claims adjudication, benefit designs/terminology, and the ability to multitask and

prioritize work. You can also work independently.

• (1) one year experience in HR and/or benefits administration and applicable laws

• Proficiency with computers, Microsoft Office, apps and instant messaging

• Proficiency with text-based communication in real-time

• Type at least 50 words per minute

• Effective communication skills; verbal and written in English

• Reading comprehension proficiency

• A good general knowledge of the general healthcare ecosystem and trends

• A relentlessly inquisitive nature, love researching and finding new answers

• A professional demeanor, especially when assisting others who are experiencing challenges

• Excellent organizational and time management skills

• The ability to multitask, while working both quickly and efficiently

• Willingness to cover night and weekend shifts, if/when required

• Friendly and helpful personality, who cares about helping others

It would be great if you have:

• Bachelor’s degree in human resources or related field of study

• SHRM Certified Professional (SHRM-CP) or HRCI Professional in Human Resources (PHR) SHRM certification

credentials.

• 2+ years’ experience working in health insurance or benefits (e.g. health brokerage, insurance, benefits advisory,

insurance adjustment, etc.) fields

• Bilingual - verbal and written in Spanish

• In-depth knowledge of the health insurance processes, including claims processing, explanation of benefits

formatting, and standard medical industry charge-off practices

• In-depth understanding of healthcare referral management practices with the ability to effectively communicate

these practices to consumers

Supervisory Duties: No supervisory duties

Travel Requirements Percentage: None- 0%

Physical and Mental Requirements:

• Occasionally move inside the office to access file cabinets, office machines, etc.  

• Prolonged periods of being stationary at a desk and working on a computer 

• Communicating with others to exchange information via typing and speaking

job description

• Must have close-range clarity of vision with or without corrective lens 

• Ability to simultaneously address multiple complex problems; Multitask without loss of efficiency or accuracy, able to

perform duties from multiple sources 

• Interact appropriately with a variety of individuals including customers, clients, and vendors and under adverse

circumstances 

• Must maintain regular attendance and be punctual 

• Must be able to exercise independent judgment and make sound decisions

What do we have that you want?

We get to change lives…every day We have an amazing team dedicated to helping people get the healthcare they need out of a

system that regularly takes advantage of them – at a price they can afford. Seriously, dedicated is an understatement. We work in a

fun, easygoing (but still fast-paced) environment and get to work together in one of the most powerful healthcare software

platforms in the world. We all have a burning desire to use that platform to help others with their healthcare challenges and we

keep an open mind for new methodologies to accomplish our mission. We want you to want to be here, so we also offer

competitive pay and benefits packages as well as an amazing culture


M-F 7pm-11pm part time
Training is 4 or more weeks 8am-5pm M-F