Experienced Premier Customer Service Advocate – arenaflex Hub – National Remote in Richardson, TX

At arenaflex, we're revolutionizing the way people interact with healthcare, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the healthcare system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.

About arenaflex

arenaflex is a leading healthcare company that's dedicated to simplifying the healthcare experience for our members. We're passionate about creating a more responsive, affordable, and equitable healthcare system that benefits everyone. Our team is made up of talented individuals who share our vision and are committed to making a positive impact on people's lives.

Job Summary

We're seeking an Experienced Premier Customer Service Advocate to join our arenaflex Hub team. As a Premier Customer Service Advocate, you'll be responsible for building trust with members across their healthcare lifecycle. You'll assist members with medical and pharmacy benefits, eligibility, claim resolution, triaging dental and vision issues, assisting with plan selection and enrollment, and improving healthcare literacy. This is a full-time position that requires flexibility to work an 8-hour shift schedule during our normal business hours of 1:30 pm - 10:00 pm CST, Monday - Friday.

Primary Responsibilities

- Provides premium level service, removing burdens and providing end-to-end resolution for members. This includes, but is not limited to: Clinical, Financial Decision Support, Behavioral Support, Claims inquiries, and more. - Provides single point of contact for the member for highly designated or dedicated arenaflex national or key account insurance plans. - Responds to and owns consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx, Pharmacy, Optum Behavioral Health, and self-service options. - Owns problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member. - Educates members about the fundamentals and benefits of consumer-driven healthcare topics to include managing their health and well-being so they can select the best benefit plan options and maximize the value of their health plan benefits. - Advocates and intervenes with care providers (doctor's offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations. - Assists the member with resolution as their advocate with 3rd party vendors. - Assists members in navigating myuhc.com and other arenaflex websites or applications utilizing remote desktop system capabilities. - Communicates and keeps consumer informed through the means in which they prefer, i.e. Phone Call, secure messaging, e-mail or chat. - Researches complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues.

Additional Responsibilities

- Answers up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans. - Performs claims adjustments/dollar payments to providers and/or members ultimately impacting arenaflex costs or commercial account costs. - Effectively refers and enrolls members to appropriate internal specialists and programs, based on member’s needs and eligibility using multiple databases. - Interprets and translates clinical / medical terminology into simple-to-understand terms for members. - Responds to and resolves on the first call, member service inquires and issues by identifying the topic and type of assistance the caller needs, such as; benefits, eligibility and claims, financial spending accounts and correspondence. - Navigates through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc. - Must remain current on all communicated changes in process and policies / guidelines. Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources. - Resolve member service inquiries related to: - Medical benefits, eligibility and claims - Terminology and plan design - Financial spending accounts - Pharmacy benefits, eligibility and claims - Correspondence requests - Educate members about the fundamentals of health care benefits including: - Managing health and well-being programs - Maximizing the value of their health plan benefits - Selecting the best health plan to meet their health needs - Choosing a quality care provider and appointment scheduling - Premium provider education and steerage - Pre-authorization and pre-determination requests and status - Benefit interpretation - Self-service tools and resources - Healthcare literacy (correspondence and literature interpretation) - Work directly with site leadership to remove process barriers - Navigate multiple online resource materials and follow defined process for issue handling - Maximize use of community services, support programs, and resources available to member

Required Qualifications

- High School Diploma / GED OR equivalent work experience - Must be 18 years of age OR older - 1+ years of experience with helping, resolving, OR advocating on behalf of members or customers - Current Tier I UNET Advocate for Me experience - Current E and I Ops Consumer Services Experience - Experience with using a computer and Microsoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), and Microsoft Outlook (email and calendar management) - Ability to work any of our 8-hour shift schedules during our normal business hours of 1:30 pm - 10:00 pm CST from Monday - Friday including the flexibility to work occasional overtime based on business need

Preferred Qualifications

- Sales OR account management experience - Healthcare / Insurance environment (familiarity with medical terminology, health plan documents, OR benefit plan design) - Social work, behavioral health, disease prevention, health promotion and behavior change (working with vulnerable populations)

Soft Skills

- Written and oral communication skills adaptable to live phone conversations as well as e-mail OR chat exchanges that drive a trusted relationship based on ownership reducing customer effort - Ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner and delivering on commitments) - Ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the members - Proficient problem-solving approach to quickly assess current state and formulate recommendations - Flexibility to customize approach to meet all types of member communication styles and personalities - Ability to overcome objections and persuade members to take action / change behavior - Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions members can understand and act upon - Conflict management skills including: - Professionally and adeptly resolving issues while under stress - Diffuse conflict and member distress - Personal resilience - Ability to utilize multiple systems / platforms while on a call with a member - strong computer skills and technical aptitude - Attention to detail - Ability to view change and transition in a positive way, and easily adapt to all updated requirements of the role - Contribute to achieving the company’s mission - Show commitment to team success over personal success. Work collaboratively with others to achieve goals - Model arenaflex's Principles of Integrity and Compliance, and adhere to our business principles - Maintain the confidentiality of sensitive information

Telecommuting Requirements

- Ability to keep all company sensitive documents secure (if applicable) - Required to have a dedicated work area established that is separated from other living areas and provides information privacy - Must live in a location that can receive a arenaflex approved high-speed internet connection or leverage an existing high-speed internet service

Compensation and Benefits

The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. arenaflex complies with all minimum wage laws as applicable. In addition to your salary, arenaflex offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase and 401k contribution (all benefits are subject to eligibility requirements).

Application Deadline

This will be posted for a minimum of 2 business days or until a sufficient candidate pool has been collected. Job posting may come down early due to volume of applicants.

Equal Employment Opportunity

arenaflex is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.

Drug-Free Workplace

arenaflex is a drug-free workplace. Candidates are required to pass a drug test before beginning employment. Apply for this job