Job Details

Job Title: Care Navigator
Business Unit: Superior HealthPlan - Member Support Center (MSC)
Location: Fully Remote (Texas)
Assignment Duration: 6 Months (Extension/Conversion Possible)
Schedule:
Hours of operation: 8:30 AM - 6:30 PM CST
Available shifts:

• 8:30 AM -5:00 PM
• 9:00 AM - 5:30 PM
• 9:30 AM - 6:00 PM
• 10:00 AM - 6:30 PM

Breaks:

• Training: 1-hour lunch
• Post-training: 30-minute lunch + two 15-minute breaks
• Overtime: Potential to support other authorization-related departments

Position Overview

The Member Services Representative supports Superior HealthPlan's STAR+PLUS Medicaid population by handling inbound calls in a fast-paced call center environment. This role provides education, support, and service coordination to Aged, Blind, and Disabled (ABD) members, ensuring access to benefits, providers, and essential services.

This position is critical in maintaining call coverage during staff leave (LOA/FMLA) and open vacancies, requiring reliable, customer-focused professionals with managed care and call center experience.

Key Responsibilities

• Handle inbound calls from STAR+PLUS Medicaid members in a call center queue environment
• Educate members on health plan benefits, covered services, and eligibility
• Assist with PCP changes, ID card requests, and benefit inquiries
• Coordinate transportation and other member services as needed
• Provide clear, empathetic support to ABD and vulnerable populations
• Document all interactions accurately using multiple systems
• Collaborate with internal teams to resolve member issues efficiently
• Maintain adherence to attendance, quality, and productivity standards
• Support additional departments during overtime or peak volume periods

Required Qualifications

Education:

• High School Diploma or GED

Experience:

• 5+ years of call center experience supporting Medicaid members, MCOs, or managed care environments
• Proven experience working with ABD (Aged, Blind, and Disabled) populations
• Demonstrated ability to support members with chronic, complex, or long-term care needs
• Experience providing care coordination within the last 3 of the past 5 years

Preferred Qualifications

• Background in Social Work, Healthcare Management, or related fields
• Clinical or healthcare support credentials (LVN, CNA, CMA, RT, Pharmacy Technician)
• Service Coordination experience
• Strong familiarity with Medicaid and managed care programs

Required Skills & Competencies

• Excellent customer service and call center communication skills
• Strong computer proficiency and ability to navigate multiple systems
• Experience with MCO insurance programs
• Ability to work independently in a remote, high-volume environment
• Reliable attendance and punctuality

Software Used:

• Microsoft Office Suite
• Avaya
• Zoom
• Skype

Disqualifiers

• No prior call center experience

Why This Role

• Fully remote opportunity within Texas
• High-impact role supporting STAR+PLUS Medicaid members
• Collaborative call center team culture
• Opportunity to gain deep experience in Medicaid managed care operations

Potential for extension or conversion based on performance