Healthcare Navigator

We are seeking a highly skilled Healthcare Navigator to join our team at Gold Coast Health Plan. As a key member of our staff, you will play a pivotal role in ensuring seamless coordination and assistance for members seeking medical support and information.

About the Role:

The Contact Center Care Coordinator I is responsible for providing outstanding customer service and support to members, caregivers, and healthcare professionals who contact Gold Coast Health Plan. This role involves managing inbound and outbound calls, emails, and other communication channels to support members in accessing healthcare services, scheduling appointments, addressing inquiries regarding medical procedures, billing, and general information enrollment, eligibility, provider network authorization, plan guidelines and processes.

Responsibilities:

• Explain GCHP procedures, protocols, benefits, services, and information to members, providers, and advocates as required through incoming calls, emails, and other communication channels promptly and professionally.
• Provide members with essential information regarding access to care, coordination of care, benefits, Evidence of Coverage (EOC), Member Handbook, etc.
• Troubleshoot and resolve escalated issues following established protocols and guidelines to escalate urgent matters or complex issues to appropriate personnel.
• Process member ID card requests and perform other Member Services related tasks, functions, and special projects.
• Assist members and caregivers in scheduling appointments, coordinating referrals, and navigating healthcare services.
• Provide accurate and up-to-date information about medical procedures, services, and facilities.
• Collaborate with healthcare providers and internal teams to ensure efficient and accurate communication of member needs and information.
• Schedule appointments, coordinate referrals, and assist members in navigating healthcare services.
• Maintain an up-to-date and thorough knowledge of GCHP guidelines.
• Properly document all calls/contacts as required by department standards in a timely, clear, and concise manner using GCHP's internal tracking system.
• Review training/educational material and seek clarification when needed.
• Achieve and maintain acceptable performance levels according to the Member Service standards.

Requirements:

• Bachelor's degree in a related field or equivalent experience preferred.
• 1-3 years of experience in Customer Service strongly preferred.
• Bilingual in English/Spanish.
• Contact center experience preferred.
• Prior experience in a healthcare setting, call center, or customer service role is advantageous.
• Strong communication skills, both verbal and written, with the ability to convey complex information in a clear and concise manner.
• Intermediate computer skills included in the MS Office products.
• Data entry experience with the ability to type a minimum of 35 words per minute.
• Excellent organizational skills and attention to detail.
• Ability to multitask, prioritize tasks efficiently, and work in a fast-paced environment.

Benefits:

• A competitive salary range of $50,000 - $65,000 annually.
• Opportunities for professional growth and development.
• A dynamic and supportive work environment.