Experienced Customer Service and Claims Representative – National Remote Opportunity for Compassionate and Results-Driven Professionals

Welcome to arenaflex

At arenaflex, we are dedicated to simplifying the health care experience, creating healthier communities, and removing barriers to quality care. Our mission is to help people live healthier lives and make the health system work better for everyone. We believe that everyone deserves the opportunity to live their healthiest life, and we are committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

Job Overview

We are seeking a highly skilled and compassionate Customer Service and Claims Representative to join our team. As a Customer Service and Claims Representative, you will play a critical role in creating a quality experience for our members and their families. You will be responsible for answering incoming phone calls, identifying the type of assistance the customer needs, and providing timely and effective solutions to their questions and concerns. You will also review and research incoming healthcare claims, ensuring that every claim has a fair and thorough review.

Key Responsibilities

• Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment and explanation of benefits (EOBs)
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
• Own problem through to resolution on behalf of the customer in real time or through comprehensive and timely follow-up with the member
• Review and research incoming healthcare claims from members and providers (doctors, clinics, etc) by navigating multiple computer systems and platforms and verifies the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
• Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction and attendance

Requirements and Qualifications

To be successful in this role, you will need to have a high school diploma or equivalent, or 10 years of equivalent work experience. You must be at least 18 years old and have a strong ability to work in a fast-paced environment. You should also have excellent communication and problem-solving skills, with the ability to quickly build rapport and respond to customers in a compassionate manner.

Essential Qualifications

• High School Diploma / GED OR 10 years of equivalent work experience
• Must be 18 years of age or older
• 2 years of previous or current claims processing experience with a claims processing system
• 1 year of customer service experience in an office or professional setting
• Ability to complete on the job training for this role during their normally scheduled 8 hour shift Monday - Friday between the hours of 7 am-8 pm CST
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime

Preferred Qualifications

• Familiarity with medical terminology, health plan documents, or benefit plan design
• Prior experience utilizing multiple systems/platforms while on a call with a member

What We Offer

At arenaflex, we offer a comprehensive benefits package, including a competitive salary, incentive and recognition programs, equity stock purchase, and 401k contribution. We also provide a supportive and inclusive work environment, with opportunities for professional growth and development. Our mission is to help people live healthier lives, and we are committed to making a positive impact on our communities.

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 high-speed internet connection or leverage an existing high-speed internet service

Career Growth and Development

At arenaflex, we are committed to helping our employees grow and develop in their careers. We offer a range of training and development programs, including on-the-job training, mentorship, and career advancement opportunities. Our goal is to help our employees build successful and fulfilling careers, and we are dedicated to providing the support and resources they need to succeed.

Work Environment and Company Culture

At arenaflex, we are proud of our inclusive and supportive work environment. We believe that diversity and inclusion are essential to our success, and we are committed to creating a workplace where everyone feels valued and respected. Our company culture is built on a foundation of integrity, compassion, and excellence, and we are dedicated to making a positive impact on our communities.

Compensation and Benefits

We offer a competitive salary and comprehensive benefits package, including medical, dental, and vision insurance, as well as a 401k plan and paid time off. We also provide a range of perks and benefits, including flexible work arrangements, employee recognition programs, and opportunities for professional growth and development.

Conclusion

If you are a compassionate and results-driven professional who is passionate about delivering exceptional customer service, we encourage you to apply for this exciting opportunity. At arenaflex, we are committed to helping people live healthier lives, and we are dedicated to making a positive impact on our communities. Join our team and start doing your life's best work.