Experienced Claim Representative – Remote Customer Service and Claims Processing

At arenaflex, we're committed to delivering exceptional customer experiences and providing top-notch claims processing services to our valued clients. As an Experienced Claim Representative, you'll play a vital role in our team, working remotely to manage authorizations, notifications, and other service requests while providing outstanding customer service. If you're passionate about the healthcare industry, possess excellent communication skills, and thrive in a fast-paced environment, we encourage you to apply for this exciting opportunity.

About arenaflex

arenaflex is a leading provider of innovative healthcare solutions, dedicated to empowering individuals and organizations to achieve their goals. Our team of experts is passionate about delivering exceptional service, and we're committed to fostering a culture of collaboration, innovation, and growth. As a remote employee, you'll enjoy the flexibility to work from anywhere, while still being part of a dynamic and supportive team.

Primary Responsibilities

As an Experienced Claim Representative, your primary responsibilities will include:

• Managing authorizations, notifications, and other service requests received via incoming phone calls, faxes, and portal submissions
• Providing excellent customer service, including the ability to handle escalated callers
• Determining authorization or notification requirements
• Preparing authorization cases for Medical Directors, Network Operations Nurses, and Case Managers
• Providing administrative approvals (depending on the line of business)
• Handling expedited authorizations, authorization updates, and status checks
• Confirming member eligibility
• Outreaching to providers and/or patients to complete authorization requests and prescriptions
• Maintaining knowledge of various health plan partner benefits, networks, CMS regulations, and health plan partner policies
• Utilizing experience and judgment to plan, accomplish goals, and effectively resolve each assigned task
• Performing all other related duties as assigned

Essential Qualifications

To succeed in this role, you'll need:

• High School Diploma or equivalent (verified through Diverse Lynx)
• 1.5 to 2 years of claims experience
• Medical Terminology knowledge
• ICD 9/ICD 10 and CPT knowledge
• Claim experience
• Call center experience
• Proficiency with Microsoft Office Word, Excel, and Outlook

Preferred Qualifications

While not required, the following qualifications will make you an even stronger candidate:

• 2+ years of combined or related experience in a healthcare, call center, and/or customer service setting using the telephone and computer as the primary instrument to perform job duties
• Ability to work one of the varying shifts to support our 24/7 operation
• Proficiency with medical terminology, ICD-9/ICD-10, and CPT knowledge
• Ability to establish a dedicated work area that is HIPAA compliant
• Ability to keep all company-sensitive documents secure (if applicable)

Skills and Competencies

To excel in this role, you'll need:

• Excellent communication and interpersonal skills
• Ability to work independently and as part of a team
• Strong problem-solving and analytical skills
• Ability to multitask and prioritize tasks effectively
• Proficiency with Microsoft Office Suite and other relevant software
• Strong knowledge of medical terminology, ICD-9/ICD-10, and CPT

Career Growth Opportunities and Learning Benefits

At arenaflex, we're committed to helping you grow and develop your skills. As an Experienced Claim Representative, you'll have access to:

• Ongoing training and development opportunities
• Mentorship and coaching from experienced professionals
• Opportunities for career advancement and professional growth
• A dynamic and supportive work environment that encourages collaboration and innovation

Work Environment and Company Culture

As a remote employee, you'll enjoy the flexibility to work from anywhere, while still being part of a dynamic and supportive team. arenaflex is committed to fostering a culture of collaboration, innovation, and growth, and we're dedicated to providing a work environment that is inclusive, diverse, and respectful.

Compensation, Perks, and Benefits

arenaflex offers a competitive compensation package, including:

• Competitive salary
• Comprehensive benefits package
• Opportunities for professional growth and development
• Flexible work arrangements
• Recognition and rewards for outstanding performance

How to Apply

If you're passionate about the healthcare industry, possess excellent communication skills, and thrive in a fast-paced environment, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to [insert contact information]. We can't wait to hear from you!

Equal Employment Opportunity

arenaflex is an Equal Employment Opportunity employer. All qualified applicants will receive due consideration for employment without any discrimination. All applicants will be evaluated solely on the basis of their ability, competence, and their proven capability to perform the functions outlined in the corresponding role. We promote and support a diverse workforce across all levels in the company. Apply for this job