[Remote] Senior Specialty Benefits Navigator at Big Health

United States

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Not SpecifiedCompensation

N/AExperience Level

N/AJob Type

Not SpecifiedVisa

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Requirements

4-6+ years in healthcare operations, case management, or revenue cycle role
Preferably in behavioral health, specialty pharmacy, or prior authorization
Strong familiarity with payer policies, clinical documentation, and pharmacy workflows
Clear and concise communicator—written and verbal—with strong documentation skills
Proven ability to stay calm and solution-focused while juggling competing priorities
Self-directed with a “get it done” mindset and high ownership over work product

Responsibilities

Own escalations end‑to‑end: Lead resolution of complex PAs, denials, step therapy overrides, tier exceptions, continuation‑of‑therapy, and reauthorization timelines
Navigate benefits expertly: Determine the correct coverage path across medical vs. pharmacy benefits, formulary status, HCPCS/CPT coding, site‑of‑care, and specialty classification
Direct payer/PBM advocacy: Conduct targeted outreach to plans and PBMs to expedite decisions, correct errors, and secure patient access
Clinic and provider support: Interface with clinicians and partner staff to identify missing documentation, clarify criteria, and align on next steps
Documentation and systems: Maintain precise status, outcomes, and next steps in EHR/CRM/Airtable; ensure audit‑ready records
Quality and mentorship: Coach BPO team members, perform case QA, and contribute to SOPs, checklists, and templates
Insights and improvement: Track payer behavior and bottlenecks, propose fixes, and partner with leadership on process and tooling improvements

Skills

Big Health

Digital health solutions for mental health care

About Big Health

Big Health provides digital solutions aimed at addressing mental health challenges such as insomnia, anxiety, and depression. Their main products, Daylight and Sleepio, offer personalized support for individuals and adolescents, while Spark Direct focuses on improving emotional well-being in practical settings. The company also runs a medication assessment program that emphasizes non-drug treatment options, which can be quickly integrated into health plans. Big Health distinguishes itself from competitors through its strong commitment to evidence-based practices, supported by over 90 peer-reviewed studies and numerous randomized controlled trials. The goal of Big Health is to make effective mental health care accessible to individuals through partnerships with employers and health plans.

San Francisco, CaliforniaHeadquarters

2010Year Founded

$125.5MTotal Funding

SERIES_CCompany Stage

Consumer Software, HealthcareIndustries

51-200Employees

Benefits

Health care - We provide 100% employee coverage for medical, vision, and dental. Plus, free access to Sleepio for poor sleep, Daylight for worry and anxiety, and additional mental health benefits.

Time off - We take balance seriously. Employees get 20 days of PTO plus eight holidays, a year-end week off, and Flex Fridays. Employees also receive 10 days of paid sick leave per year.

Professional development - Employees receive a $1k USD or £800 stipend — plus five paid days off — for professional development, plus a stipend for their work-from-home setup.

Retirement savings - US Employees are eligible to participate in a 401(k) program with company match, and UK employees receive a pension program with NEST.

Team building - Apart, but never alone. We host an annual Summit in-person at our SF HQ (virtual when needed), and regular social events to keep bonds strong.

Family - Employees are eligible for parental leave on day one. Dependents are eligible for 50% coverage on our medical, vision and dental plans, plus access to Sleepio and Daylight.

Risks

Increased competition from similar digital health platforms may dilute market share.

Integration challenges from Limbix acquisition could affect operational efficiency.

Rapid expansion into adolescent mental health may stretch resources and divert focus.

Differentiation

Big Health offers non-drug, evidence-based digital therapeutics for mental health issues.

The company has over 90 peer-reviewed publications, including 18 randomized controlled trials.

Big Health's products, Daylight and Sleepio, are clinically validated for anxiety and insomnia.

Upsides

Partnership with Grow Therapy enhances platform with integrated provider network for comprehensive care.

Acquisition of Limbix expands offerings to include adolescent mental health solutions like SparkRx.

Inclusion in Evernorth Digital Health Formulary increases access to Daylight and Sleepio.

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