**Experienced Customer Service Representative – Remote Claims Inquiry/Claims Research Team**

At arenaflex, we're committed to delivering exceptional customer experiences that exceed our members' expectations. As a key member of our Claims Inquiry/Claims Research team, you'll play a vital role in providing top-notch support to our healthcare providers and plan sponsors. If you're passionate about delivering world-class customer service, have a knack for problem-solving, and thrive in a fast-paced, dynamic environment, we want to hear from you! **About arenaflex** arenaflex is a leading healthcare company dedicated to transforming the way we deliver care. Our purpose is to bring our heart to every moment of your health, and we're committed to making healthcare more personal, convenient, and affordable. With a focus on innovation and customer-centricity, we're constantly pushing the boundaries of what's possible in healthcare. **Our Heart At Work Behaviors** At arenaflex, we believe that our employees are the heartbeat of our organization. Our Heart At Work Behaviors are designed to empower our team members to feel valued, supported, and empowered to make a meaningful impact. These behaviors include: * **Empathy**: We put ourselves in our customers' shoes and strive to understand their needs and concerns. * **Collaboration**: We work together as a team to achieve common goals and deliver exceptional results. * **Innovation**: We're always looking for new and better ways to solve problems and improve our services. * **Accountability**: We take ownership of our actions and results, and we're committed to continuous learning and improvement. **Job Summary** As an Experienced Customer Service Representative on our Claims Inquiry/Claims Research team, you'll be responsible for providing exceptional customer service to our healthcare providers and plan sponsors. You'll work closely with our team to resolve complex claims issues, provide accurate and timely information, and ensure that our customers receive the support they need to succeed. **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 provide excellent customer service for high-volume inbound provider calls. * Conduct extensive claims research on multiple platforms to assist providers with payment questions. * 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 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 and assist providers on our self-service options. * Assist providers with credentialing and re-credentialing and contracting questions and issues. * Assist in compiling claim data for customer audits. * Determine medical necessity, applicable coverage provisions, and verify member plan eligibility relating to incoming correspondence and internal referrals. **Work Environment** As a remote employee, you'll have the flexibility to work from the comfort of your own home. You'll need to have a dedicated workspace with a direct connection to the router (not Wi-Fi) and a high-speed internet connection (100 Mbps or higher). We provide a 6-foot-long Ethernet cord, but if the distance is further, you'll need to provide your own Ethernet cable. **Required Qualifications** * Familiarity with Microsoft Office products such as Word, Teams, and Excel. * Ability to maneuver through multiple applications to gather information while on a call. * Experience in a highly transactional call center environment. * Excellent customer service and critical thinking skills. * High school diploma or GED equivalent. * Must secure high-speed internet access (100 Mbps or higher) and consistent, stable connection. A speed test will be required to proceed with an interview. **Preferred Qualifications** * Healthcare background. * Experience working in a remote or virtual environment. **Education** * High school diploma or GED equivalent. **Pay Range** The typical pay range for this role is $17.00 - $28.46 per hour. The actual base salary offer will depend on a variety of factors, including experience, education, geography, and other relevant factors. **Benefits** At arenaflex, we're committed to providing our employees with a comprehensive benefits package that includes: * 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. * CVS store discount. * Discount programs with participating partners. * Paid Time Off (PTO) or vacation pay. * Paid holidays throughout the calendar year. **Equal Opportunity Employer** arenaflex is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law. **How to Apply** If you're passionate about delivering exceptional customer service and have a knack for problem-solving, we want to hear from you! Please visit our website to learn more about this opportunity and to apply. The application window for this opening will close on September 28, 2024. Apply Job! Apply for this job