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

At arenaflex, we're dedicated to delivering exceptional customer experiences that make a lasting impact. 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 that's revolutionizing the way we approach health care. Our purpose is simple: to bring our heart to every moment of your health. We believe that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose, empowering our employees to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make health care more personal, convenient, and affordable.

Job Summary

As a Customer Service Representative on our Claims Inquiry/Claims Research team, you'll be responsible for providing exceptional customer service to high-volume inbound provider calls. You'll work closely with our members, providers, and plan sponsors to resolve issues, answer questions, and provide related information to answer the unasked questions. Your expertise in claims research, customer service, and critical thinking will be essential in making financial decisions to resolve member issues and explaining member rights and responsibilities in accordance with contract.

Key Responsibilities

* Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors

• Triages resulting rework to appropriate staff
• Provide excellent customer service for high-volume inbound provider calls for the Claims Inquiry/Claims Research team
• Extensive claims research on multiple platforms to assist providers with payment questions
• Provides the customer with related information to answer the unasked questions, e.g., additional plan details, benefit plan details, member self-service tools, etc.
• Uses customer service threshold framework to make financial decisions to resolve member issues
• Explains member's rights and responsibilities in accordance with contract
• Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance, and appeals (member/provider) via target system
• Educates & assists providers on our self-service options
• Assists providers with credentialing and re-credentialing and contracting questions and issues
• Assists in compiling claim data for customer audits
• Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility relating to incoming correspondence and internal referrals

Work Environment and Schedule

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

• 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 highly transactional call center environments
• Excellent customer service and critical thinking skills
• High school diploma or GED equivalent

Preferred Qualifications

* Healthcare background

Education and Training

* arenaflex offers a range of development courses and training programs to help you grow and succeed in your role

• You'll have access to our online learning platform, where you can take courses and earn certifications to enhance your skills and knowledge

Compensation and Benefits

* The typical pay range for this role is $17.00 - $28.46 per hour

• arenaflex offers a comprehensive benefits package, including medical, dental, and vision benefits, as well as a 401(k) retirement savings plan and an Employee Stock Purchase Plan
• You'll also have access to paid time off, paid holidays, and other time-off benefits
• arenaflex provides a fully-paid term life insurance plan to eligible employees, as well as short-term and long-term disability benefits

Career Growth Opportunities

* arenaflex is committed to helping you grow and succeed in your career

• We offer a range of career development opportunities, including promotions, transfers, and lateral moves
• You'll have access to our mentorship program, where you can connect with experienced colleagues and learn from their expertise

Work-Life Balance

* arenaflex values work-life balance and offers a range of benefits to help you achieve it

• You'll have access to our employee assistance program, which provides confidential support and resources to help you manage work and personal life
• arenaflex also offers flexible scheduling and telecommuting options to help you balance your work and personal responsibilities

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. Apply now to join our Claims Inquiry/Claims Research team as a Customer Service Representative. Apply for this job