Insurance Navigation Specialist

Job Description

Job Description

Insurance Navigation Specialist

Rate of Pay: $27 per hour. WCDC provides medical, dental, and vision insurance; PTO, paid holidays, jury duty, and bereavement leave; a 401(k) retirement plan; short‑term and long‑term disability; an Employee Assistance Program (EAP); a quarterly incentive program; and tribal‑discretion COLA adjustments.

Reports to: Member Services Manager

Position Summary

The Insurance Navigation Specialist supports members in accessing affordable healthcare by assisting with financial aid applications, insurance enrollment, coverage navigation, and healthcare advocacy. This role serves as a key resource for members, providers, and clinic staff by ensuring accurate patient financial and insurance information and helping individuals maximize healthcare benefits and resources.

Key Responsibilities

Financial Assistance & Application Support

• Receive, review, and process all financial aid applications to ensure completeness and accuracy.
• Assist members in gathering and submitting required documentation for financial aid and insurance applications.
• Collaborate with counselors, peer support staff, and other team members to obtain necessary verification documents.
• Monitor application status and communicate updates to patients as needed.

Insurance Enrollment & Eligibility Assistance

• Assist individuals with health coverage application processes, including Medicaid and Health Insurance Marketplace enrollment.
• Review eligibility determinations and provide guidance on enrollment options.
• Educate members on insurance requirements, benefits, and available coverage options.
• Support members with maintaining active insurance coverage and resolving enrollment-related issues.

Member Account & Insurance Verification

• Review member accounts and insurance profiles to ensure accurate demographic, financial, and coverage information.
• Identify and resolve discrepancies that may impact claims processing, billing, or eligibility.
• Maintain accurate documentation in electronic health record systems

Member Advocacy & Healthcare Navigation

• Assist members in navigating Medicaid and other insurance-related concerns, including coverage, benefits, summaries of benefits, and eligibility requirements.
• Serve as a member advocate by assisting with the resolution of medical billing issues both within the organization and with our referral partners
• Guide members through complex healthcare systems and connect them with appropriate community and healthcare resources.

Internal Resource & Collaboration

• Serve as a subject matter resource for providers, clinical staff, and administrative teams regarding insurance-related questions.
• Collaborate with interdisciplinary teams to coordinate member support services and address barriers to care.
• Stay informed about changes in Medicaid, Marketplace plans, and financial assistance programs.

Minimum Qualifications

• High school diploma or GED required.
• Minimum 2 years of experience in insurance navigation, financial counseling, patient financial services, healthcare access, or a related field.
• Working knowledge of Medicaid, Health Insurance Marketplace plans, and healthcare financial assistance programs.
• Experience assisting individuals with application processes, eligibility determination, and documentation requirements.
• Strong customer service, communication, and problem-solving skills.
• Proficiency with electronic health records (EHRs) and Microsoft Office applications.
• Ability to manage multiple cases, maintain accurate records, and meet deadlines.
• Ability to handle sensitive and confidential information in accordance with HIPAA requirements.

Preferred Qualifications

• Associate's degree in Healthcare Administration, Social Work, Human Services, Public Health, Business Administration, or a related field.
• Certified Application Counselor (CAC), Certified Navigator, or similar healthcare enrollment certification.
• Experience working in a community health center, behavioral health organization, hospital, or healthcare setting.
• Knowledge of healthcare billing processes, claims issues, and insurance appeals.

Equal Employment Opportunity (EEO) Statement

We Care Daily Clinics is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. All employment decisions are based on qualifications, merit, and business need—without regard to race, color, religion, creed, national origin, ancestry, gender, gender identity or expression, sexual orientation, age, marital status, disability, veteran status, genetic information, or any other protected status under applicable laws.

Tribal Preference Statement

In accordance with applicable Tribal and Federal laws, Tribal preference will be given to qualified candidates who are members of a federally recognized tribe. We Care Daily Clinics and Indigenous Pact are proud to partner with Tribal communities to expand access to high-quality, culturally grounded care.