Care Navigator

• Serve as the warm, persistent point of contact for members with confusing bills, denials, or complex questions
• Help members navigate the appeals process and review complex cases
• Review EOBs to identify errors and advocate for members
• Coordinate between members and providers to resolve billing and coverage issues end to end
• Help members and providers understand prior authorization requirements and ensure submissions are correct and timely, including specialty and pharmacy pre-authorization
• Translate plan design and benefits into plain language
• Direct members toward high-value, in-network care and providers through administrative navigation
• Flag patterns in claims and costs to support plan improvements
• Connect members with external partners and internal teams