**Experienced Customer Service Representative - Federal FFS at arenaflex**

At arenaflex, we're dedicated to delivering exceptional customer experiences that make a lasting impact on our members' lives. As a Customer Service Representative, you'll be the face of arenaflex, playing a vital role in transforming our culture and accelerating our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable. **About arenaflex** arenaflex is a leading healthcare company that's passionate about putting our heart into caring for our colleagues and our communities. Our purpose is to bring our heart to every moment of our members' health, and we're committed to delivering enhanced human-centric healthcare for a rapidly changing world. With a strong brand that's anchored in our values, we're dedicated to empowering our employees to make a difference in the lives of our members. **Our Heart At Work Behaviors** Our Heart At Work Behaviors support our purpose and guide our commitment to delivering exceptional customer experiences. We want everyone who works at arenaflex to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions. Our Heart At Work Behaviors include: * Empathy: We listen actively and respond with compassion and understanding. * Accountability: We take ownership of our actions and decisions, and we're responsible for our results. * Collaboration: We work together as a team to achieve our goals and deliver exceptional customer experiences. * Innovation: We're curious and open to new ideas, and we're committed to finding creative solutions to complex problems. * Integrity: We act with honesty, transparency, and ethics in all our interactions. **Position Summary** As a Customer Service Representative, you'll be responsible for handling customer inquiries and resolving issues via telephone, internet, or written correspondence. You'll engage with members, providers, and plan sponsors to understand their unique needs and preferences, and you'll educate them on Aetna plans, tools, and resources to help guide them along a clear path to care. Your responsibilities will include: * Handling customer inquiries and resolving issues in a timely and professional manner * Engaging with members, providers, and plan sponsors to understand their unique needs and preferences * Educating members on Aetna plans, tools, and resources to help guide them along a clear path to care * Answering questions and resolving issues based on phone calls/letters from members, providers, and plan sponsors * Triaging resulting rework to appropriate staff * Documenting and tracking contacts with members, providers, and plan sponsors * Guiding members through their plan of benefits, Aetna policy and procedures, and resources to comply with regulatory guidelines * Creating an emotional connection with our members by understanding and engaging them to the fullest to champion for their best health * Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member * Anticipating customer needs and providing related information to answer unasked questions * Using customer service threshold framework to make financial decisions to resolve member issues * Explaining member's rights and responsibilities in accordance with contract * Processing claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance and appeals (member/provider) via target system * Educating providers on our self-service options; Assisting providers with credentialing and re-credentialing issues * Responding to requests received from arenaflex's Law Document Center regarding litigation; lawsuits * Handling extensive file review requests * Assisting in preparation of complaint trend reports * Assisting in compiling claim data for customer audits * Determining medical necessity, applicable coverage provisions and verifying member plan eligibility relating to incoming correspondence and internal referrals * Handling incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management * Performing review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible * Performing financial data maintenance as necessary * Using applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received **Required Qualifications** * Must be able to commute on-site to High Point, NC office 5 days per week during first 8 weeks of initial training. Team will transition to full-time work from home following training. * Customer Service experiences in a transaction-based environment such as a call center, demonstrating ability to be empathetic and compassionate. * Experience in a production environment. **Preferred Qualifications** * Medical Terminology and/or Provider office experience. * Understanding of insurance concepts and processes. **Education** * High School or GED equivalent. **Pay Range** The typical pay range for this role is: $17.00 - $25.65 This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors. **Benefits** In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. arenaflex offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. arenaflex provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. arenaflex also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, arenaflex employees enjoy Paid Time Off (“PTO”) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time, and other time off are provided consistent with relevant state law and Company policies. **Career Growth Opportunities and Learning Benefits** arenaflex is committed to helping you grow and develop your skills and knowledge. We offer a range of training and development programs, including: * On-the-job training and coaching * Online learning platforms and courses * Leadership development programs * Mentorship opportunities * Career advancement opportunities **Work Environment and Company Culture** arenaflex is a dynamic and fast-paced work environment that's passionate about delivering exceptional customer experiences. We're committed to creating a culture that's inclusive, diverse, and supportive, and we're dedicated to empowering our employees to make a difference in the lives of our members. Our company culture is built on our Heart At Work Behaviors, which include empathy, accountability, collaboration, innovation, and integrity. **How to Apply** If you're passionate about delivering exceptional customer experiences and making a difference in the lives of our members, we encourage you to apply for this exciting opportunity. Please visit our website at [insert website URL] to learn more about this role and to submit your application. The application window for this opening will close on: 08/23/2024. **Equal Employment Opportunity** arenaflex is an equal employment opportunity employer and welcomes applications from diverse candidates. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws. Apply Job! Apply for this job