Experienced Claims Customer Service Advocate II – Delivering Exceptional Support and Resolution Expertise in a Dynamic and Innovative Environment at arenaflex

Introduction to arenaflex

arenaflex is a leading organization with a rich history of delivering outstanding service to its customers. With a strong presence in the community and a commitment to innovation, we have established ourselves as a trusted and reliable partner. Our diverse family of subsidiary companies enables us to build on a variety of business strengths, and we operate one of the most sophisticated data processing centers in the region. As a dynamic and forward-thinking company, we are dedicated to providing exceptional support and resolution expertise to our customers, and we are seeking a talented and experienced Claims Customer Service Advocate II to join our team.

Job Overview

In this critical role, you will be responsible for responding to routine and non-routine inquiries, performing research as needed to resolve inquiries, and reviewing and adjudicating claims and/or non-medical appeals. You will determine whether to return, deny, or pay claims following organizational policies and procedures, ensuring effective customer relations and delivering accurate, timely, and courteous support to our customers. As a Claims Customer Service Advocate II at arenaflex, you will be an integral part of our team, working collaboratively to provide exceptional service and support to our customers.

Key Responsibilities

• Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
• Handle situations that may require adaptation of response or extensive research, identifying incorrectly processed claims and processing adjustments and reprocessing actions according to department guidelines.
• Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines, entering claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Ensure claims are processing according to established quality and production standards, identifying complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and referring these to a lead or manager for resolution.
• Identify and report potential fraud and abuse situations, maintaining confidentiality and discretion when handling sensitive information.

Essential Qualifications

To be successful in this role, you will need:

• High School Diploma or equivalent
• Two years of customer service experience, including one year of claims or appeals processing, or a Bachelor's Degree in lieu of work experience.
• Good verbal and written communication skills, with strong customer service skills and good spelling, punctuation, and grammar skills.
• Basic business math proficiency and the ability to handle confidential or sensitive information with discretion.

Preferred Qualifications

We prefer candidates with:

• One year of call center experience with claims experience, demonstrating a strong understanding of claims processing and customer service principles.

Skills and Competencies

To excel in this role, you will need to possess:

• Excellent communication and interpersonal skills, with the ability to work collaboratively in a team environment.
• Strong problem-solving and analytical skills, with the ability to adapt to changing situations and priorities.
• Good time management and organizational skills, with the ability to prioritize tasks and manage multiple projects simultaneously.
• A strong commitment to customer service and a passion for delivering exceptional support and resolution expertise.

Career Growth Opportunities and Learning Benefits

At arenaflex, we are committed to providing our employees with opportunities for growth and development. As a Claims Customer Service Advocate II, you will have access to training and development programs, as well as opportunities for advancement and career progression. You will be part of a dynamic and innovative team, working collaboratively to deliver exceptional service and support to our customers.

Work Environment and Company Culture

arenaflex is a diverse and inclusive organization, committed to providing a positive and supportive work environment. We value our employees and recognize the importance of work-life balance, offering a range of benefits and perks to support your well-being and career goals. Our company culture is built on a foundation of respect, integrity, and excellence, and we are seeking individuals who share these values and are passionate about delivering exceptional service and support to our customers.

Compensation, Perks, and Benefits

As a Claims Customer Service Advocate II at arenaflex, you will be eligible for a range of benefits, including:

• 401K retirement savings plan with company match
• Subsidized health plans, dental and vision coverage
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition and employee assistance programs
• Discounts to movies, theaters, zoos, theme parks, and more

Conclusion

If you are a motivated and experienced customer service professional, looking for a challenging and rewarding role in a dynamic and innovative environment, we encourage you to apply for the Claims Customer Service Advocate II position at arenaflex. As a valued member of our team, you will have the opportunity to deliver exceptional support and resolution expertise to our customers, while developing your skills and advancing your career. Join us at arenaflex and be part of a team that is dedicated to excellence and committed to making a positive impact in the lives of our customers.