**Experienced Customer Service Representative – Heart of Healthcare**

At arenaflex, we're not just a healthcare company – we're a team of passionate individuals dedicated to delivering exceptional care and services to our members. Our purpose is simple yet powerful: Bringing our heart to every moment of your health. We believe that how we deliver our services is just as important as what we deliver, and that's why we're looking for talented Customer Service Representatives to join our team. **About arenaflex** arenaflex is a leading healthcare company that's committed to transforming the way healthcare is delivered. With a focus on innovation, convenience, and affordability, we're making healthcare more personal and accessible to our members. Our Heart At Work Behaviors support our purpose and guide our actions every day. We're a team of passionate individuals who are dedicated to making a difference in the lives of our members. **Job Summary** We're seeking experienced Customer Service Representatives to join our Meritain Health's Call Center team in Buffalo, NY. As a Customer Service Representative, you'll be the first point of contact for our members, providing exceptional service and support via telephone, internet, or written correspondence. You'll be responsible for handling customer inquiries and resolving issues in a timely and professional manner. If you're passionate about delivering exceptional customer service and making a difference in the lives of our members, we want to hear from you! **Key Responsibilities** * Handle customer service inquiries and problems via telephone, internet, or written correspondence * Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors * Triage resulting rework to appropriate staff * Document and track contacts with members, providers, and plan sponsors * Guide members through their plan of benefits, Aetna policy, and procedures * Create an emotional connection with our members by understanding and engaging with them to champion their best health * Take accountability to fully understand the member's needs by building a trusting and caring relationship with the member * Anticipate customer needs and provide related information to answer unasked questions * Use customer service threshold framework to make financial decisions to resolve member issues * Explain member's rights and responsibilities in accordance with contract * Process claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance, and appeals (member/provider) via target system * Educate providers on our self-service options and assist with credentialing and re-credentialing issues * Respond to requests received from Aetna's Law Document Center regarding litigation and lawsuits * 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** * Customer Service experience in a transaction-based environment such as a call center or retail location, demonstrating ability to be empathetic and compassionate * Experience in a production environment * High School Diploma, GED, or equivalent experience **Preferred Qualifications** * Experience in a healthcare setting or related industry * Knowledge of healthcare policies, procedures, and regulations * Experience with customer relationship management (CRM) software and other relevant systems **Skills and Competencies** * Excellent communication and interpersonal skills * Ability to work in a fast-paced environment and prioritize tasks effectively * Strong problem-solving and analytical skills * Ability to work independently and as part of a team * Strong customer service skills and a passion for delivering exceptional service * Ability to adapt to changing priorities and deadlines * Strong organizational and time management skills * Ability to maintain confidentiality and handle sensitive information **Career Growth Opportunities and Learning Benefits** At arenaflex, we're committed to helping our employees grow and develop their careers. We offer a range of training and development programs, including: * On-the-job training and mentorship * Online training and development courses * Leadership development programs * Career advancement opportunities * Opportunities for professional growth and development **Work Environment and Company Culture** We're proud of our company culture and work environment, which is built on our Heart At Work Behaviors. We're a team of passionate individuals who are dedicated to making a difference in the lives of our members. Our work environment is collaborative, supportive, and inclusive, and we're committed to creating a workplace that's welcoming and inclusive for all employees. **Compensation, Perks, and Benefits** We offer a competitive compensation package, including: * Base hourly rate of $17.50/hour * Merit-based bonuses and commission opportunities * Comprehensive benefits package, including medical, dental, and vision insurance * 401(k) retirement savings plan and Employee Stock Purchase Plan * Paid time off (PTO) and paid holidays * Flexible work arrangements and remote work options * Access to our Employee Assistance Program (EAP) * Discounts on CVS Health products and services * Opportunities for professional growth and development **How to Apply** If you're passionate about delivering exceptional customer service and making a difference in the lives of our members, we want to hear from you! Please submit your application, including your resume and cover letter, to our online application portal. **Equal Employment Opportunity** arenaflex is an equal employment opportunity employer and welcomes applications from diverse candidates. We're committed to creating a workplace that's inclusive and welcoming for all employees, and we're proud to be an equal opportunity employer. **Contact Us** If you have any questions or would like more information about this opportunity, please don't hesitate to contact us. We look forward to hearing from you! Apply Job! Apply for this job