Member Care Navigator (On-Site or Remote)

About the role

The OccuNet Company is an innovative healthcare cost-containment organization committed to improving access to affordable, high-quality healthcare. We pride ourselves on an outward-mindset culture that values empathy, respect, and seeing one another as whole people. Our team thrives in a fast-paced, growth-oriented environment where continuous learning and collaboration drive our success.

What it’s Like to Work Here

At OccuNet, you matter like we matter! Our team members share a positive attitude, an outward mindset, problem-solving abilities, and patience, enabling them to provide excellent customer service even during challenging situations. Our culture, plus continuous opportunities for growth, has resulted in an industry-low turnover rate. Don’t miss out on this rare opening with us!

Duties & Responsibilities

• Answer incoming calls and support members in scheduling appointments and accessing appropriate care.
• Maintain open, continuous communication between members and providers.
• Research accepting physicians or facilities based on plan design, member needs, and access barriers.
• Partner closely 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 ensuring timely follow up, documentation, and clear next steps.
• Make outbound calls to providers, clients, and partners to gather information, educate stakeholders, and provide updates.
• Attend training and team meetings to stay current on workflows, tools, and plan updates.

Required Skills & Qualifications

• A 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.

Success Indicators

• A successful Care Navigator consistently demonstrates:
• High-quality member experience characterized by trust, clarity, and empathy.
• Timely and accurate case documentation and workflow adherence.
• Ability to professionally overcome provider resistance.
• Strong cross-functional collaboration.
• Sound judgment, composure, and reliability under pressure.
• Ownership and follow-through on all assigned cases.

Culture and Opportunities

We pride ourselves on our outward mindset – supporting each other and putting the team and the clients we serve first. High-growth environment with clear opportunities for career growth. Welcoming atmosphere and culture.

Benefits

• 401(k) with matching
• Dental insurance
• Health insurance
• Vision insurance
• Health savings account
• Paid time off

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