CareFirst

Resp & Qualifications

PURPOSE: 
CareFirst Engagement Center (CEC) Service Navigators provide members with a superior customer experience by welcoming guests into the Engagement Centers and helping them navigate the healthcare system, CareFirst resources, and community-based social services. This role serves as a trusted resource for current and prospective members by assessing needs, educating individuals on benefit plans, healthcare programs, costs, and available resources, and helping members make informed decisions that positively impact their health and well-being.

Service Navigators build strong relationships across CareFirst and with community partners to resolve complex service issues, advocate for members, and connect individuals to the programs and services that best meet their needs. This position requires a passion for in-person customer service, the ability to effectively manage multiple priorities, and a commitment to delivering exceptional member experiences across all CareFirst lines of business.

Candidates must be available to work weekends as needed, travel regularly within the CareFirst service region, and be able to lift, move, and carry materials weighing up to 20 pounds.
ESSENTIAL FUNCTIONS:

• Provide an exceptional in-person member experience by welcoming members, guests, and prospective members to CareFirst Engagement Centers; assessing needs; building trusted relationships; and serving as a knowledgeable advocate and resource throughout the healthcare journey.
• Investigate and resolve complex member service issues, including claims, eligibility, billing, benefits, and healthcare program inquiries by gathering and analyzing information, verifying understanding, examining claim activity as needed, and applying appropriate policies and procedures to achieve timely resolution.
• Educate and empower members by utilizing knowledge of CareFirst products, programs, benefits, tools, and healthcare services to explain coverage, benefit utilization, available resources, and self-service options while helping members make informed healthcare decisions.
• Identify and address member health and social needs by engaging members to understand healthcare, psychosocial, economic, and community-related challenges and connecting them with appropriate CareFirst programs, wellness resources, and community-based services.
• Support Engagement Center operations and community outreach efforts by managing and coordinating center programming, wellness activities, educational events, fitness classes, outreach opportunities, and special projects that promote member engagement and community well-being.
• Drive operational excellence and continuous improvement by maintaining accurate documentation, prioritizing workflow in a fast-paced environment, collaborating with internal partners to resolve recurring issues, identifying process improvement opportunities, exercising sound judgment, and contributing to a culture of teamwork, quality, and exceptional service.

QUALIFICATIONS:
Education Level: Bachelor's Degree OR in lieu of a Bachelor's degree, an additional 4 years of relevant work experience is required in addition to the required work experience.
Experience: 3 years related experience
Preferred Qualifications:

• Fluent bilingual proficiency in Spanish and English.
• Experience providing in-person customer service.
• Experience coordinating programming and schedules for community-facing locations such as health clinics, fitness centers, retail locations, community centers, or similar environments.
• Experience working with healthcare, social service, or community outreach programs.
  

Knowledge, Skills and Abilities (KSAs) 

• Demonstrated commitment to service excellence, including a proven track record of achieving high customer satisfaction and consistently exceeding performance expectations and service standards.
• Strong communication and relationship-building skills, with the ability to establish trust and collaborate effectively with members, community partners, and internal stakeholders across all levels of the organization.
• Excellent problem-solving, analytical, and decision-making abilities, including the capacity to assess complex situations, identify solutions, and exercise sound judgment in a fast-paced environment.
• Strong organizational and time management skills, with the ability to prioritize competing demands, manage multiple tasks simultaneously, and maintain accuracy and attention to detail.
• Proficiency in CRM systems, customer engagement practices, and healthcare service delivery, including knowledge of healthcare benefits, programs, community resources, and member advocacy principles.
• Ability to work both independently and collaboratively, demonstrating adaptability, leadership, motivation, and a commitment to teamwork and continuous improvement.

Salary Range: 54,504 - 108,251

Salary Range Disclaimer

The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements).

Equal Employment Opportunity

CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer.  It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information.

Federal Disc/Physical Demand

Note:  The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs.

PHYSICAL DEMANDS:

The associate is primarily seated while performing the duties of the position.  Occasional walking or standing is required.  The hands are regularly used to write, type, key and handle or feel small controls and objects.  The associate must frequently talk and hear.  Weights up to 25 pounds are occasionally lifted.

Sponsorship in US

Must be eligible to work in the U.S. without Sponsorship.

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