Experienced Customer Service Representative – Healthcare Industry Expert – Work from Home Opportunity in IL

At arenaflex, we're building a world of health around every consumer and surrounding ourselves with dedicated colleagues who are passionate about transforming health care. As the nation's leading health solutions company, we reach millions of Americans through our local presence, digital channels, and more than 300,000 purpose-driven colleagues – caring for people where, when, and how they choose in a way that is uniquely more connected, more convenient, and more compassionate. And we do it all with heart, each and every day.

Join arenaflex's Center of Excellence Customer Service Group

We are currently recruiting top talent for our Center of Excellence Customer Service group. As a Customer Service Representative, you will be the face of arenaflex and impact members' service experience by manner of how customer service inquiries and problems via telephone, internet, or written correspondence are handled. You will engage, consult, and educate members based upon the member's unique needs, preferences, and understanding of arenaflex plans, tools, and resources to help guide the members along a clear path to care.

Responsibilities:

* Handle customer inquiries and resolve issues based on phone calls/letters from members, providers, and plan sponsors

• Triages resulting rework to appropriate staff
• Document and track contacts with members, providers, and plan sponsors
• Guide the member through their member's plan of benefits, arenaflex policy, and procedures as well as having knowledge of resources to comply with any regulatory guidelines
• Create an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' 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 the 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
• Assist providers with credentialing and re-credentialing issues
• Respond to requests received from arenaflex's Law Document Center regarding litigation; lawsuits
• Handle extensive file review requests
• Assist in preparation of complaint trend reports
• 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
• 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:

* 1 year of Customer service experience

• Must reside in IL
• Ability to multi-task to accomplish workload efficiently
• Oral and written communication skills
• Ability to maintain accuracy and production standards
• Technical skills
• Problem-solving skills
• Attention to detail and accuracy

Preferred Qualifications:

* 1 year of healthcare experience

• 1 year of call center experience

Education:

* High School or GED equivalent

Anticipated Weekly Hours:

* 40 hours per week

Time Type:

* Full-time

Pay Range:

* The typical pay range for this role is: $17.00 - $31.30

• 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.

Join a Diverse and Inclusive Team:

Our people fuel our future. Our teams reflect the customers, patients, members, and communities we serve, and we are committed to fostering a workplace where every colleague feels valued and that they belong. Great benefits for great people – we take pride in our comprehensive and competitive mix of pay and benefits – investing in the physical, emotional, and financial wellness of our colleagues and their families to help them be the healthiest they can be.

Benefits:

* Affordable medical plan options

• A 401(k) plan (including matching company contributions)
• An employee stock purchase plan
• No-cost programs for all colleagues, including:

+ Wellness screenings + Tobacco cessation and weight management programs + Confidential counseling and financial coaching

• Benefit solutions that address the different needs and preferences of our colleagues, including:

+ Paid time off + Flexible work schedules + Family leave + Dependent care resources + Colleague assistance programs + Tuition assistance + Retiree medical access + Many other benefits depending on eligibility

Why Work at arenaflex?

Our Work Experience is the combination of everything that's unique about us: our culture, our core values, our company meetings, our commitment to sustainability, our recognition programs, but most importantly, it's our people. Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful. They make choices according to what is best for the team, they live for opportunities to collaborate and make a difference, and they make us the #1 Top Workplace in the area.

Apply Now:

If you're passionate about transforming health care and want to join a dynamic team, apply now to become an arenaflex Customer Service Representative. Apply for this job