Member Navigator

Vālenz Health® is the destination for employers, brokers, payers, and providers to reduce costs, improve quality, and elevate the healthcare experience. Through advanced technology and clinical expertise, Valenz creates a distinctly different approach to a complex healthcare system. With our solutions, we execute across the entire healthcare journey — from member experience to payment integrity, provider quality, and plan performance. With one of America’s largest cost, quality and utilization datasets, we create greater transparency, flexibility, and cost containment — empowering members and employers with the information they need to make smarter, more cost-effective decisions.

About This Opportunity:
As a Member Navigator, you’ll serve as a primary non-clinical point of contact for members, providing end-to-end support across assigned healthcare programs and services. You’ll help members navigate their experience by answering questions, explaining program benefits and processes, gathering and verifying required information, researching and resolving routine issues, coordinating appointments and services, and ensuring timely follow-up through resolution. You’ll collaborate with members, providers, clients, clinical teams, and internal business partners to facilitate timely access to care and deliver a seamless member experience. You’ll also maintain accurate case documentation, identify and address barriers, escalate complex or clinical matters to the appropriate resources, and provide support across programs and workflows as business needs evolve.

Things You’ll Do Here:

- Serve as a primary point of contact for members through phone, email, and other communication channels, providing timely, professional, and compassionate assistance.

- Educate members regarding applicable programs, benefits, processes, eligibility requirements, available services, provider options, and next steps.

- Gather, verify, and accurately document demographic information, eligibility information, benefit information, referrals, service needs, and other information required to support the member's case.

- Research member, provider, or client questions using available systems, resources, and established program guidelines; resolve routine issues independently and escalate complex, clinical, or non-standard matters appropriately.

- Coordinate the end-to-end scheduling process for imaging and other applicable healthcare services, including identifying appropriate providers, facilitating appointments, confirming scheduling details, and communicating updates to members and providers.

- Coordinate with Case Management, clinical staff, or other internal teams when a member requires clinical review, surgical support, additional care coordination, or services outside the Navigator's non-clinical scope.

- Manage assigned member cases through appropriate resolution, including monitoring progress, conducting follow-up, identifying barriers to service, and coordinating next steps with the appropriate stakeholders.

- Maintain complete and accurate documentation of member interactions, case activity, scheduling information, outcomes, and follow-up requirements in applicable CRM, scheduling, case management, and other departmental systems.

- Facilitate effective communication among members, providers, clients, clinical teams, and internal departments to support timely service delivery and a positive member experience.

- Build and maintain productive working relationships with provider facilities and other external partners.

- Identify service issues, potential escalations, or barriers to timely care and take appropriate action within established procedures to support resolution.

- Assist with claims-related, administrative, and operational activities associated with member cases as needed.

- Meet established quality, productivity, service level, documentation, and member experience expectations.

- Maintain working knowledge of assigned programs,