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

At arenaflex, we're committed to delivering exceptional customer experiences that exceed expectations. As a Customer Service Representative on our Claims Inquiry/Claims Research team, you'll play a vital role in providing top-notch support to our members, providers, and plan sponsors. If you're passionate about delivering personalized care and have a knack for resolving complex issues, 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 shaping the future of healthcare and creating a better world for our members and communities.

Our Heart At Work Behaviors

At arenaflex, we believe that our employees are the heartbeat of our organization. Our Heart At Work Behaviors support our purpose and guide our actions. We want everyone who works with us to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions. Our behaviors include:

• Empathy: We put ourselves in others' shoes 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 delivering high-quality work.

Job Summary

As a Customer Service Representative on our Claims Inquiry/Claims Research team, you'll be responsible for:

• Answering questions and resolving issues based on phone calls/letters from members, providers, and plan sponsors.
• Triaging resulting rework to appropriate staff and providing excellent customer service for high-volume inbound provider calls.
• Conducting extensive claims research on multiple platforms to assist providers with payment questions.
• Providing related information to answer unasked questions, such as additional plan details, benefit plan details, and member self-service tools.
• Using our 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, grievances, and appeals via our target system.
• Educating and assisting providers on our self-service options.
• Assisting providers with credentialing and re-credentialing and contracting questions and issues.
• 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.

Work Hours and Environment

* This role is fully remote, and you must live in the EST, PST, or CST time zones.

• Work hours are 7am to 7pm local time.
• You'll need to secure high-speed internet access (100 Mbps or higher) and a consistent, stable connection.
• A speed test will be required to proceed with an interview.
• You'll need to set up your work location with a direct connection to the router (not Wi-Fi).

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.

Preferred Qualifications

* Healthcare background.

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 offer 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 experiences and have a knack for resolving complex issues, we want to hear from you! Please visit our website to learn more about this opportunity and to apply. Apply Job! Apply for this job