Job summary
Seeking a Care Navigator to assist members enrolled in a U.S. health insurance plan by helping them understand their benefits, navigate billing and claims issues, and ensure access to appropriate in-network care. The role involves coordinating between members, providers, and payers, reviewing explanations of benefits, and advocating for members when claims are denied or complicated.
Location and work setup
- Location
- Norway
- Work setup
- Remote
Responsibilities
Serve as the primary contact for members with complex billing questions or claim denials. Guide members through the appeals process, review explanation of benefits (EOBs) to identify errors, and coordinate resolution of billing and coverage issues with providers. Assist members and providers with prior authorizations, ensuring submission accuracy and timeliness. Translate insurance plan details and benefits into understandable language. Recommend high-value, in-network care options. Identify patterns in claims and costs to contribute feedback for plan improvement.
Qualifications
Several years' experience in a medical-administrative or patient-facing coordination role involving claims, medical billing, and pre-authorizations. Ability to interpret EOBs and familiarity with CPT and ICD coding. Strong coordination skills to manage communication across members, providers, and payers. Warm and clear communication style. Prior experience working on the payer side or claims administration, BCPA certification, or clinical-adjacent background is a plus.