Health Navigator- Member Outreach

BlueCross BlueShield of Tennessee (BCBST) is seeking a Health Navigator to join our highly collaborative BlueCare Plus Member Outreach team. In this role, you’ll make a meaningful impact on both member health outcomes and our Stars performance- the Medicare quality rating system that evaluates how well health plans serve their members across measures like preventive care, customer service, and overall experience. You’ll support this work by conducting outbound calls, assisting members with closing gaps in care, and scheduling key preventive appointments. You’ll also educate members on available benefits and services, complete health needs assessments, refer members to population health programs, and manage system work queues to ensure timely outreach and proper routing to the clinical team. This position operates Monday–Friday, 8:45 AM–5:15 PM EST, within a remote‑first environment supported by a fully developed team and established processes.

We’re looking for someone with strong customer service experience, experience working with the senior population, the ability to work independently, patience, familiarity with medical terminology, and a willingness to adapt to new technology — including the use of AI‑enabled tools. If you’re passionate about guiding members through their healthcare journey and contributing to improved outcomes, we encourage you to apply!

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

1

Worker Type:

Employee

Company:

BCBST BlueCross BlueShield of Tennessee, Inc.

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.