Health Benefits Navigator (Call Center) at ConsumerMedical (work from home opportunity)

Medical/Healthcare Las Vegas, Nevada


Health Benefits Navigator (Call Center - Work from Home Opportunity)
Shifts available:  11:30 a.m. to 8:00 p.m. ET and 2:30 p.m. to 11:00 p.m. ET

ConsumerMedical ( is a leading healthcare decision support and concierge company serving over 3.5 million individuals through some of the nation's largest employers, health plans and private exchanges. As a Medical Ally, ConsumerMedical guides participants throughout their healthcare journey with compassionate, high-touch support and deep clinical expertise.

ConsumerMedical offers a fully integrated suite of solutions including Medical Decision Support, Expert Medical Opinions, Claims Advocacy and more, helping individuals and families navigate the healthcare system while reducing unnecessary elective surgeries and driving patients to the highest quality providers. The result is better care for patients, more empowered healthcare decisions for employees and their families, and a better bottom line for business. The company is headquartered outside Boston in Pembroke, MA.

We are currently hiring a Health Benefits Navigator (Call Center - Work from Home opportunity) who will be the first point of contact for our participants.  We are looking for someone who understands basic clinical terminology, has worked in a customer service environment, enjoys speaking on the phone and has at least one year of experience working with consumers in a health-related environment. 

Job Responsibilities

  • Handle incoming, outgoing, email and chat communication within a call center environment
  • Assist participants in navigating their employer benefit suite, including their health plan, pharmacy resource, general benefits administration and the like, with goal of driving resolution on behalf of the participant by connecting them to the appropriate resource and assisting in resolution
  • Recognizing/acknowledging the need for additional research in order to resolve any unresolved issues, and handle associated casework
  • Build effective rapport with customer vendor partners and use expertise to ensure that all the needs of the participant(s) are identified and addressed
  • Prioritize the most important service needed on behalf of the participant (coaching, information, emotional support, web navigation, health benefit navigation)
  • Responsible for educating and promoting CM services that are available with a goal of increasing engagement
  • Utilizing interpersonal skills and training to provide professional, knowledgeable, helpful, courteous, and responsive customer service
  • Work closely with the nurse team and/or other teams to determine best method to satisfy participants need(s)
  • Comfortable communicating medical information to a non-medical audience
  • Access customer accounts and product information, by toggling between multiple screens and systems, to provide accurate answers and support within the parameters of policies and procedures
  • Conduct feedback surveys with participants to evaluate satisfaction, utilization of services provided and impact of CM services
  • On-going training provided by ConsumerMedical and self-study
  • Staying current on customer programs and workflows through on-going communications

Desired Skills and Experience:

  • Excellent telephone manner and skills
  • Must have at least three (3) years of customer service experience
  • Must have at least one (1) year of telephonic experience discussing confidential medical information to consumers
  • Experience with navigating employer health benefits including health care coverage, pharmacy benefits, general benefits administration etc.; patient advocacy
  • Dedicated to providing high quality, professional, customer service
  • Enthusiastic, must enjoy working independently and in a team environment
  • Bi-lingual in English/Spanish a plus
  • Proficient with Microsoft Office Suite (Excel, Word, Outlook, Power point)
  • Flexible and willing to perform other tasks as assigned
  • Excellent written and verbal communication skills
  • Must be comfortable with a fast-paced, evolving operation
  • Experience with resolving complex participant issues regarding billing, claims, benefits and general inquires


Applicants, as well as position incumbents, who become disabled as defined under the Americans with Disabilities Act must be able to perform the essential job functions (as listed) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.

ConsumerMedical is committed to the principle of equal employment opportunity.  Applicants for employment and employees are reviewed on their individual qualifications for a position.  Under no circumstances will ConsumerMedical discriminate against qualified persons on the basis of race, color, religious creed, retaliation, national origin, ancestry, sexual orientation, gender, gender identity/expression, disability, mental illness, genetics, choice of health insurance, marital status, age, veteran status, or any other basis prohibited under applicable law.