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

Join arenaflex, a leading healthcare company dedicated to delivering enhanced human-centric health care for a rapidly changing world. As a Customer Service Representative on our Claims Inquiry/Claims Research team, you will play a vital role in providing exceptional customer service to high-volume inbound provider calls, resolving issues, and ensuring seamless communication between members, providers, and plan sponsors.

About arenaflex

arenaflex is a healthcare company that puts its heart into caring for its colleagues and communities. Our purpose is to bring our heart to every moment of your health, and our Heart At Work Behaviors support this purpose by empowering our employees to transform our culture and accelerate innovation. We are committed to delivering solutions that make healthcare more personal, convenient, and affordable.

Position Summary

This is a fully remote role, and you must live in the Eastern Standard Time (EST), Pacific Standard Time (PST), or Central Standard Time (CST) time zones. As a Customer Service Representative, you will:

• Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors
• Triage resulting rework to appropriate staff and provide excellent customer service for high-volume inbound provider calls
• Conduct extensive claims research on multiple platforms to assist providers with payment questions
• Provide related information to answer unasked questions, such as additional plan details, benefit plan details, and member self-service tools
• Use a 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 and assist providers on our self-service options
• Assist providers with credentialing and re-credentialing and contracting questions and issues
• 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

Work Hours

* 7am to 7pm local time

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 environment
• Excellent customer service and critical thinking
• Must secure high-speed internet access (100 mbps or higher) and consistent, stable connection
• Work location must be set up with a direct connection to the router (NOT Wi-Fi)

Preferred Qualifications

* Healthcare background

Education

* High School diploma or GED equivalent

Pay Range

The typical pay range for this role is: $17.00 - $28.46 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.

Benefits

arenaflex offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. The Company provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. arenaflex also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, Company employees enjoy Paid Time Off ("PTO") or vacation pay, as well as paid holidays throughout the calendar year.

Equal Opportunity Employer

arenaflex is an equal opportunity and affirmative action employer. We do not discriminate in recruiting, hiring, promotion, or any other personnel action based on race, ethnicity, color, national origin, sex/gender, sexual orientation, gender identity or expression, religion, age, disability, protected veteran status, or any other characteristic protected by applicable federal, state, or local law.

How to Apply

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