Client Concierge Specialist

Client Concierge Specialist

The Client Concierge Specialist delivers high-touch, white-glove service experience 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 by providing personalized support related to benefits, claims, eligibility, provider navigation, and issue resolution. The goal is that every interaction is handled with ownership and empathy, while employing proactive problem-solving. This position combines strong customer service skills with healthcare knowledge to proactively anticipate needs, resolve inquiries efficiently, and enhance overall member satisfaction.

Duties and 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. This involves research and identifying root causes of denials/underpayments and other errors and gathering what is needed to resolve the issues. Identify the reason for the escalation and provide research until resolution is reached
• Update and maintain accurate records of progress, action taken, pending items and status; communicate updates to internal and external stakeholders. Escalate unresolved or high-impact issue appropriately.
• Meet or exceed performance metrics including quality, accuracy, call handling time, time to resolution, work volume and member satisfaction.
• Deliver empathetic, professional communication and support retention by creating positive and seamless interactions

Requirements:

Required Knowledge, Skills, and Abilities:

• High school graduate or equivalent. Associates or Bachelor level degree preferred.
• 2+ years of experience in a customer service or call center environment handling escalation/2nd tier inquires in a healthcare, insurance or TPA environment.
• Comfortable supporting multiple channels and adjusting to dynamic workloads
• Familiarity with call center metrics and quality standards; Experience with claims processing, benefits, eligibility systems preferred
• Experience with CRM systems or customer support platforms preferred
• Experience in working escalations through emails and spreadsheets meeting timely resolution
• Previous exposure to workforce management or scheduling tools
• Solid working knowledge of standard computer applications including MS Word, Excel, Outlook, and PowerPoint
• Ability using a computer which includes expert keyboard and navigation skills and learning new programs
• Communicate clearly and professionally with internal and external customers
• Work effectively individually and as part of a team to achieve established outcomes. Understand other's roles and empower one another to take responsibility to be successful.
• Demonstrate collaborative interactions with peers to reach a common goal as well as be a resource to team members and internal/external customers
• Pay close attention to detail in all aspects of the job
• Make decisions using available resources and sound judgment
• Maintain confidentiality and discretion
• Identify and resolve problems in a timely manner, gather and analyze information skillfully and proactively
• Share knowledge with associates by effectively communicating and providing follow-up
• Open to other's ideas and exhibits a willingness to try new things.
• Demonstrate accuracy and thoroughness; monitor work to ensure quality.
• Prioritize and plan work activities to use time efficiently.
• Adapt to changes in the work environment, manage competing demands and is able to deal with frequent changes, delays, or unexpected events.
• Follows instructions, responds to direction, and solicits feedback to improve.
• Act in such a way to instill trust from management, other associates, as well as customers.
• Work overtime as required

Physical and Cognitive Demands:

• Constant: Talk, hear, speak, and use hands and fingers to operate a computer, telephone, keyboard/mouse; occasionally move about the office
• Constant: Visual ability such as close vision, distance vision, color and peripheral vision, depth perception and ability to adjust focus
• Occasional: Lift and/or move up to 15 pounds
• Constant: Regular, predictable attendance in the office is required
• Constant: While performing the duties of this job, the employee is regularly sitting for the full shift
• Constant: The cognitive skills needed to complete tasks include abilities such as learning, remembering, focusing, categorizing, and integrating information for decision making, problem-solving, and comprehending.

Work Environment:

• The physical environment is indoors in a controlled climate, office setting. The noise level may be low to moderate.

The duties described are representative, but not restrictive of tasks that may be assigned or of the abilities required to do the job. The description is subject to change at any time. Other related duties may be assigned. This description does not alter the at-will status of employment.

Pay may vary based on location. Offers will be adjusted based on an individual's experience, education, and other job-related factors as permitted by law. Pay range is: $23-26.00/per hour