Health Navigator

We are hiring a Health Navigator at BCBST!

In this role, you will support the BlueCare Plus Clinical Support team by serving as a key point of contact for members, helping them navigate their healthcare needs with compassion and confidence. You’ll assist members by answering questions, completing Health Risk Assessments, and ensuring timely support through both phone interactions and administrative responsibilities.

You will play an important role in improving the member experience by responding to inquiries through a dedicated phone line, addressing a variety of needs with empathy, and helping members access the services and care they need. Your work will directly contribute to smoother coordination of care and stronger member engagement.

To be successful in this role, you’ll bring strong communication skills, patience, and the ability to work independently in a remote environment. Ideal candidates will have at least one year of experience in a medical office setting or working with senior populations, along with knowledge of medical terminology.

We foster a culture where innovation is encouraged. That includes using AI enabled tools responsibly to support everyday work — guided by proven workflows, templates, and policies. As roles become more advanced, we expect employees to leverage AI more broadly to transform how we serve members.

Note:

• This is a remote role within a collaborative and supportive team environment
• Schedule: Rotating shifts of 8:00–4:30 p.m., 8:30–5:00 p.m., and 9:00–5:30 p.m. EST, with occasional coverage until 6:00 p.m. as needed

Job Responsibilities

• Conducting educational telephone calls advising members of available benefits, services and programs; completes health needs assessment, and refers members to population health management programs as appropriate.
• Reaching out to members with identified gaps in care; encouraging and motivating them to become compliant; offering assistance in locating providers and appointment scheduling.
• Managing system work queues; screening identified members for eligibility, prior case activities, recent claims, customer service inquiries and authorization history; assigning members to clinical team for call outreach and intervention.
• Facilitating research and analysis of inquiries and/or complaints related to processes and designations, member lost incentives, and other program related inquiries.
• Work overtime as needed
• Various immunizations and/or associated medical tests may be required for this position.
• This job requires digital literacy assessment. 

Job Qualifications

Education

• Associates Degree in, education, communication, or health related field or equivalent work experience

Experience

• 2 years - Experience in a customer service support role is required

Skills\Certifications

• Ability to work independently with minimal supervision or function in a team environment sharing responsibility, roles and accountability.
• Proficient interpersonal and organizational skills
• Independent, Sound decision-making and problem-solving skills
• Must be able to work in an independent and creative manner.
• Self-motivated and able to manage multiple tasks and set priorities.
• Effective time management skills
• Excellent oral and written communication skills
• Strong interpersonal and organizational skills
• Knowledge in Medical terminology

Number of Openings Available

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Applying for this job indicates your acknowledgement and understanding of the following statements:

BCBST will recruit, hire, train and promote individuals in all job classifications without regard to race, religion, color, age, sex, national origin, citizenship, pregnancy, veteran status, sexual orientation, physical or mental disability, gender identity, or any other characteristic protected by applicable law.

Further information regarding BCBST's EEO Policies/Notices may be found by reviewing the following page:

BCBST's EEO Policies/Notices

BlueCross BlueShield of Tennessee is not accepting unsolicited assistance from search firms for this employment opportunity. All resumes submitted by search firms to any employee at BlueCross BlueShield of Tennessee via-email, the Internet or any other method without a valid, written Direct Placement Agreement in place for this position from BlueCross BlueShield of Tennessee HR/Talent Acquisition will not be considered. No fee will be paid in the event the applicant is hired by BlueCross BlueShield of Tennessee as a result of the referral or through other means.