Healthcare Concierge & Claims Navigator

Leading Edge; New York (NY, TX); Hybrid; USD 32,000 - 36,000; Full time

Job summary

Leading Edge is seeking a Client Concierge Specialist to deliver high-touch support to members, providers, and clients within a health insurance environment. This role serves as a single point of contact, guiding members through their healthcare journey with personalized assistance and proactive problem-solving.

Responsibilities include handling inquiries across channels, educating on benefits, verifying eligibility, and navigating claims.

Responsibilities

• Serve as the primary point of contact for inbound calls, emails, and digital inquiries from members and providers.
• Deliver personalized, concierge-level service by understanding member needs and providing tailored solutions which include outbound contacts.
• Assist members with benefits education, eligibility verification, and plan navigation.
• Guide members through claims inquiries, including status, processing, and explanation of benefits (EOBs) ensuring delivery in an understandable, polite manner.
• Support provider searches, appointment coordination, and healthcare navigation.
• Research and resolve complex issues related to claims, billing, and coverage.
• Investigate and resolve disputes/escalations, identifying root causes of denials/underpayments and gathering what is needed to resolve.
• Update and maintain accurate records of progress, escalations, pending items and status; communicate updates to stakeholders.
• Meet or exceed performance metrics including quality, accuracy, call handling time, time to resolution, and member satisfaction.
• Deliver empathetic, professional communication to support retention and positive interactions.

Job description

Leading Edge is seeking a Client Concierge Specialist to deliver high-touch support to members, providers, and clients within a health insurance environment. This role serves as a single point of contact, guiding members through their healthcare journey with personalized assistance and proactive problem-solving.

Responsibilities include handling inquiries across channels, educating on benefits, verifying eligibility, and navigating claims.