Introduction Indulge your passion for problem-solving and embrace the thrill of addressing risk head-on at Gallagher's global brokerage team. Join a family of diverse minds, united by a relentless pursuit of excellence. As part of our team, you'll be the architect of protection, safeguarding businesses and empowering their ambitions. Together, we'll build a legacy of trust and triumph in the dynamic world of risk management. We believe that every candidate brings something special to the table, including you! So, even if you feel that you’re close but not an exact match, we encourage you to apply. Overview The Participant Navigator is responsible for providing advanced support and advocacy to health plan participants. This mid-level role involves collaborating with participants, healthcare providers, internal teams, and our claims administrator to address complex issues, improve health outcomes, and enhance participant satisfaction. The Participant Navigator will utilize their expertise in claims, insurance, and medical coding to work with key stakeholders and internal teams, ensuring participants receive high-quality, coordinated care. How you'll make an impact Serve as a key liaison to assist participants in identifying and accessing in-network providers, preferred providers, centers of excellence, and cost-effective treatment options. Guide participants through the healthcare system, including understanding their benefits, accessing care, and coordinating services. Educate members on the Kairos services available. Provide personalized guidance to participants on selecting the lowest-cost, highest-quality healthcare services within their network. Support participants with scheduling appointments, obtaining referrals, and understanding pre-authorization requirements. Instruct participants in using digital tools, such as provider directories or cost-comparison platforms, to make informed healthcare decisions. Provide advanced medical expertise on claims adjudication and review of high-dollar claims. Educate participants on the claims process and assist them in understanding their claims and benefits. Demonstrate a comprehensive understanding of medical/health insurance terminology, HIPAA and DOL regulations, self-funded insurance plans, and PPO networks. Collaborate with the claims administrator to resolve discrepancies and expedite the processing of claims. Collect and analyze data to evaluate the effectiveness of clinical interventions and program initiatives. Conduct outreach and engagement activities to align with the health plan's goals and objectives. Partner with Nurse Navigators to identify and assess participant needs. Manage incoming and outgoing correspondence, including phone calls, emails, and mail. Act as a liaison between account managers and nurse navigators to support reporting efforts. Exhibit a strong commitment to delivering compassionate, personalized service while maintaining professionalism and empathy. Skills for success Strong communication skills: ability to effectively communicate and present to groups and individuals. Critical thinking and problem-solving skills: assess health needs, identify risk factors, and develop appropriate interventions. Organizational and time management skills: manage multiple tasks and prioritize workload effectively. Flexibility and adaptability: ability to adjust approach and strategies based on the needs of individuals and groups. Collaboration and teamwork: work effectively with other healthcare professionals, groups, and community organizations. Professionalism and ethical conduct: adhere to ethical and legal standards in healthcare practice and maintain confidentiality. Continued learning and adaptability: willingness to learn and adapt to new software systems and technological advancements. About You Associates degree or equivalent required; additional education or certifications in healthcare or related fields preferred. 2-4 years of experience in healthcare, preferably within a provider's office, health plan or managed care organization. In-depth knowledge of healthcare billing and reimbursement processes. Proficiency in using claims management software and communication and collaboration tools: email, video conferencing, PowerPoint, Excel, Microsoft. Advanced knowledge of managed care with emphasis on use of criteria, guidelines, and national standards of practice. Compensation and benefits On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits. Below are the minimum core benefits you’ll get, depending on your job level these benefits may improve: Medical/dental/vision plans, which start from day one! Life and accident insurance 401(K) and Roth options Tax-advantaged accounts (HSA, FSA) Educational expense reimbursement Paid parental leave Other benefits include: Digital mental health services (Talkspace) Flexible work hours (availability varies by office and job function) Training programs Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing Charitable matching gift program And more... We value inclusion and diversity Click Here to review our U.S. Eligibility Requirements Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on race, color, religion, creed, gender (including pregnancy status), sexual orientation, gender identity (which includes transgender and other gender non-conforming individuals), gender expression, hair expression, marital status, parental status, age, national origin, ancestry, disability, medical condition, genetic information, veteran or military status, citizenship status, or any other characteristic protected (herein referred to as “protected characteristics”) by applicable federal, state, or local laws. Equal employment opportunity will be extended in all aspects of the employer-employee relationship, including, but not limited to, recruitment, hiring, training, promotion, transfer, demotion, compensation, benefits, layoff, and termination. In addition, Gallagher will make reasonable accommodations to known physical or mental limitations of an otherwise qualified person with a disability, unless the accommodation would impose an undue hardship on the operation of our business.