Benefits Navigator

Location 1000 Midlantic Drive,Mount Laurel Township, NJ, 08054,United States Base Pay $23.00 - $26.00 / Hour Employee Type FT Non-Exempt The Benefits Navigator/Advocate is a high‑touch, non‑clinical healthcare navigation and member advocacy role. The Advocate works one‑on‑one with members, including employees, dependents, and early retirees, to help them understand their benefits, navigate the healthcare system, resolve issues, access appropriate resources, and reduce avoidable healthcare friction and cost. HealthActive combines human advocacy, proactive outreach, and data‑informed next best actions to help members use healthcare more effectively. The Advocate plays a central role in delivering that experience by supporting members with empathy, clarity, and follow‑through while helping drive engagement, improved outcomes, and measurable value for clients. Key Responsibilities Member Advocacy and Navigation Serve as a trusted resource for members as they navigate healthcare questions, benefit concerns, provider access issues, and care‑related barriers. Help members understand and use their health benefits, including medical, pharmacy, and ancillary benefits where applicable. Assist members with locating appropriate in‑network providers, understanding available care options, preparing for provider conversations, and navigating referrals, authorizations, claims, denials, and billing issues. Support members in accessing second‑opinion resources, specialized programs, and other available plan or vendor resources without providing clinical advice or making medical decisions. Provide empathetic support during complex, confusing, or stressful healthcare situations and elevate urgent, complex, or clinical matters appropriately. Cost, Benefits, and Resource Guidance Explain coverage, benefit design, network rules, out‑of‑pocket cost considerations, claims, and administrative processes in clear, member‑friendly language. Help members identify lower‑cost, high‑quality care options when available and appropriate. Help members avoid unnecessary, duplicative, or poorly coordinated care by guiding them to appropriate resources and helping them understand available options. Identify when a member may benefit from specialized benefit solutions, including programs related to MSK, diabetes, behavioral health, pharmacy, wellness, second opinions, or other client‑sponsored resources, and help route them appropriately. Proactive Outreach and Engagement Conduct proactive outreach based on defined program priorities, claims‑informed cohorts, gaps in care, seasonal campaigns, and next best action opportunities. Engage members in a practical, supportive manner to help them understand available benefits, programs, and resources. Support outreach related to preventive care, chronic condition management, medication adherence, care gaps, high‑cost claims patterns, and appropriate use of available programs. Help drive HealthActive program engagement, utilization, member satisfaction, and measurable value. Documentation, Compliance, and Case Management Document all member interactions, outreach activity, issue resolution steps, referrals, and outcomes in the appropriate CRM or care platform. Maintain accurate, timely, and complete case notes. Protect member privacy and maintain HIPAA compliance at all times. Follow approved communication protocols for phone, email, text, and other member engagement channels. Identify recurring member issues, access barriers, or process gaps and elevate trends to leadership as appropriate. Success Measures Success in this role may be measured by member satisfaction, timely case resolution, quality and completion of proactive outreach, member engagement, accurate documentation, successful routing to appropriate resources, and contribution to gap closure, cost avoidance, improved access, and better use of available healthcare resources where measurable. Requirements Required 2+ years of experience in healthcare customer service, member services, benefits navigation, care coordination, call center support, case management support, or a related healthcare support role. Strong customer service, communication, and relationship‑building skills. Ability to explain complex healthcare and benefits information in simple, practical terms. Strong problem‑solving skills, sound judgment, organization, follow‑through, and multitasking ability. High degree of empathy, patience, and professionalism when supporting members through stressful or confusing situations. Comfort working in CRM, case management, or other technology platforms. Ability to maintain confidentiality and follow HIPAA requirements. Preferred Experience with employer‑sponsored health plans, claims, networks, referrals, prior authorizations, denials, pharmacy benefits, or member advocacy. Familiarity with medical terminology. Experience supporting members with chronic condition, high‑cost, or complex healthcare needs. Familiarity with specialized benefit solutions, wellness programs, or care navigation resources. 401k contribution Generous vacation time Opportunity to grow All qualified applicants will receive consideration for employment without regard to race, age, color, ancestry, national origin, place of birth, religion, sex, sexual orientation, gender identity and expression, military or veteran status, genetic characteristics, or disability unrelated to job performance. #J-18808-Ljbffr Kids for the Future