Healthcare Case Specialist

This is a remote position. At this time, we are unable to consider candidates residing in CA, NY, MA, NJ, or WA. Applicants from all other U.S. states are encouraged to apply. REQUIRED: As part of the application process, all candidates must complete a Culture Index profile. Applications will not be considered until the profile is completed. Please complete the assessment at: https://go.cultureindex.com/p/49rRU4LIGMLDWK Position Summary We are seeking a dependable, detail-oriented Healthcare Case Specialist (also known as Member Advocate in CareGuide) to provide thorough, accurate, and compassionate support to members navigating complex healthcare and medical billing systems. This role is ideal for someone who values precision, consistency, and quality service while building trust through clear, reliable communication. Member Advocates are the heart and voice of the organization, providing compassionate, strategic, and results-oriented support to members navigating complex healthcare systems. They serve as key liaisons between members, healthcare providers, internal teams, and external partners. From medical bill negotiation to facility coordination and case documentation, this role is integral to both member experience and organizational impact. Member Advocates ensure every member feels seen, heard, and supported while driving measurable savings and satisfaction outcomes. This role requires strong communication and organizational skills, the ability to handle sensitive medical information with discretion, and a commitment to maintaining compliance with HIPAA regulations. Candidates with experience as a Healthcare Case Manager, Claims Coordinator, Litigation Support Specialist, Medical Secretary, Medical Administrative Assistant, Medical Records Specialist, Patient Service Representative, Medical Transcriptionist, or Medical Biller are strongly encouraged to apply. Bilingual candidates are highly desirable and will thrive in this diverse and dynamic environment. REQUIRED: As part of the application process, all candidates must complete a Culture Index profile. Applications will not be considered until the profile is completed. Please complete the assessment at: https://go.cultureindex.com/p/49rRU4LIGMLDWK What YOU Will Do This posting provides a general overview of the role and does not include all daily responsibilities or essential job functions.

• Serve as the trusted advocate by delivering professional, empathetic customer service and maintaining clear, reliable communication with members and healthcare providers.
• Manage a caseload with accuracy and timeliness, coordinating appointments, provider research, financial assistance applications, and settlements.
• Investigate and resolve medical billing concerns, negotiate cost reductions with providers, and identify prescription or financial aid programs to ease members’ financial burdens.
• Draft and prepare settlement offers, appeal letters, and other documentation while ensuring compliance with HIPAA, legal requirements, and partner standards.
• Enter and maintain accurate records in case management systems, track deadlines, monitor progress, and ensure cases are resolved effectively.
• Address member complaints fairly, identify administrative or process gaps, and provide feedback to strengthen internal tools, workflows, and service delivery.
• Collaborate with internal teams on case handling, structured reporting, and special projects to support organizational goals.

REQUIRED: As part of the application process, all candidates must complete a Culture Index profile. Applications will not be considered until the profile is completed. Please complete the assessment at: ​https://go.cultureindex.com/p/49rRU4LIGMLDWK

Requirements

• High school diploma or equivalent required; Associate or Bachelor’s degree in a health-related, business, or social service field is a plus
• 2+ years of experience in healthcare navigation, billing, advocacy, case management, or a customer-facing role
• Experience working with vulnerable populations or navigating complex systems is strongly preferred
• Experience handling high-pressure situations with empathy, patience, and professionalism
• Prior experience in medical billing or insurance negotiations is a plus
• Familiarity with HIPAA and healthcare confidentiality standards

Bonus Points for Experience In:

• Bilingual abilities are a plus
• Experience in sensitive negotiations with healthcare providers and billing offices to achieve positive outcomes for members
• Experience in managing high caseloads and utilizing case management systems.

REQUIRED: As part of the application process, all candidates must complete a Culture Index profile. Applications will not be considered until the profile is completed. Please complete the assessment at: ​https://go.cultureindex.com/p/49rRU4LIGMLDWK Benefits · Make a Difference: Help businesses and employees lower healthcare costs while improving their access to care. · Structured & Supportive Environment: We provide clear processes, strong leadership, and a team-oriented culture where you can thrive. · Growth Potential: We invest in our people. This role has clear pathways for career advancement. · Work-Life Balance: At this time, we are unable to consider candidates residing in CA, NY, MA, NJ, or WA. Applicants from all other U.S. states are encouraged to apply. · The base salary range for this position is budgeted at $55,000-$60,000. · We also offer a competitive benefits package that includes medical, dental, and vision insurance, wellness resources, 401(k) matching, unlimited paid time off, and more. REQUIRED: As part of the application process, all candidates must complete a Culture Index profile. Applications will not be considered until the profile is completed. Please complete the assessment at: https://go.cultureindex.com/p/49rRU4LIGMLDWK ​ Apply tot his job Apply To this Job