Experienced Customer Service Representative – Delivering Personalized Health Care Solutions with Compassion and Empathy at arenaflex

Introduction to arenaflex At arenaflex, we are driven by a single, clear purpose: Bringing our heart to every moment of your health. This purpose guides our commitment to deliver enhanced human-centric health care for a rapidly changing world. Our brand, with heart at its center, sends a personal message that how we deliver our services is just as important as what we deliver. We are looking for a dedicated and compassionate Customer Service Representative to join our team and make a meaningful difference in the lives of our members. Job Overview As a Customer Service Representative at arenaflex, you will be the face of our organization, impacting members' service experience by handling customer service inquiries and problems via telephone, internet, or written correspondence. Your role will involve engaging, consulting, and educating members based on their unique needs, preferences, and understanding of arenaflex plans, tools, and resources. You will guide members along a clear path to care, creating an emotional connection and championing their best health. Key Responsibilities Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors. Triage resulting rework to appropriate staff and document and track contacts with members, providers, and plan sponsors. Guide members through their plan of benefits, arenaflex policy and procedures, and knowledge of resources to comply with regulatory guidelines. Create an emotional connection with members by understanding and engaging them to the fullest to champion their best health. Take accountability to fully understand members' needs by building a trusting and caring relationship with them. Anticipate customer needs and provide related information to answer unasked questions, such as additional plan details, benefit plan details, and member self-service tools. Use customer service threshold framework to make financial decisions to resolve member issues. Explain members' rights and responsibilities in accordance with contracts. Process claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance, and appeals (member/provider) via target system. Educate providers on self-service options and assist with credentialing and re-credentialing issues. Respond to requests received from arenaflex's Law Document Center regarding litigation and lawsuits, and handle extensive file review requests. Assist in preparation of complaint trend reports and compile claim data for customer audits. Determine medical necessity, applicable coverage provisions, and verify member plan eligibility relating to incoming correspondence and internal referrals. Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. Perform financial data maintenance as necessary. Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. Essential Qualifications To be successful in this role, you should have: High School or GED equivalent. Customer Service experience in a transaction-based environment, such as a call center or retail location, demonstrating the ability to be empathetic and compassionate. Ability to multi-task to accomplish workload efficiently. Understanding of medical terminology. Proficient oral and written communication skills. Proficient with Microsoft Word and Outlook. Ability to maintain accuracy and production standards. Negotiation skills. Technical skills. Problem-solving skills. Attention to detail and accuracy. Analytical skills. Preferred Qualifications Preferred candidates will have: Experience in a production environment. Previous experience working in a 24/7 customer service inbound call operation. Ability to work any shift, including overnights, weekends, and holidays. Career Growth Opportunities and Learning Benefits At arenaflex, we are committed to the growth and development of our employees. As a Customer Service Representative, you will have access to various training programs, workshops, and development courses to enhance your skills and knowledge. You will also have opportunities to move into different roles within the organization, such as team lead, supervisor, or other specialized positions. Work Environment and Company Culture arenaflex is a dynamic and inclusive workplace that values diversity, equity, and inclusion. We believe in creating a positive and supportive work environment that encourages collaboration, creativity, and innovation. Our employees are passionate about delivering exceptional customer service and making a meaningful difference in the lives of our members. Compensation, Perks, and Benefits The typical pay range for this role is $17.00 - $29.88 per hour. In addition to your compensation, you will enjoy a comprehensive benefits package, including: Medical, dental, and vision benefits. 401(k) retirement savings plan. Employee Stock Purchase Plan. Fully-paid term life insurance plan. Short-term and long-term disability benefits. Well-being programs. Education assistance. Free development courses. Discount programs with participating partners. Paid Time Off (PTO) or vacation pay. Paid holidays throughout the calendar year. Conclusion If you are a compassionate and dedicated individual who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity to join the arenaflex team. As a Customer Service Representative, you will play a critical role in making a meaningful difference in the lives of our members. Apply now and take the first step towards a rewarding and challenging career with arenaflex. Apply for this job