**Experienced Bilingual Customer Service Representative (English + Spanish) – Healthcare Industry**

At arenaflex, we're dedicated to delivering exceptional customer experiences that make a meaningful difference in people's lives. As a Bilingual Customer Service Representative, you'll play a vital role in shaping the future of healthcare by providing top-notch support to our members, providers, and plan sponsors. If you're passionate about delivering empathetic and personalized service, we want to hear from you!

• *About arenaflex**

arenaflex is a leading healthcare organization that's committed to transforming the way people experience healthcare. Our purpose is to bring our heart to every moment of your health, and we're driven by a passion for innovation, excellence, and compassion. With a strong focus on customer-centricity, we're dedicated to delivering enhanced human-centric healthcare that's tailored to the unique needs of our members.

• *Our Heart At Work Behaviors**

At arenaflex, we believe that our employees are the heartbeat of our organization. That's why we've developed our Heart At Work Behaviors, which are designed to empower our team members to make a meaningful impact in their roles. These behaviors include:

• **Empathy**: We believe in understanding and relating to our members' experiences, needs, and emotions.
• **Innovation**: We're committed to finding new and better ways to deliver exceptional customer experiences.
• **Collaboration**: We work together as a team to achieve our goals and make a positive impact.
• **Accountability**: We take ownership of our actions and decisions, and we're accountable for delivering results.
• **Integrity**: We operate with transparency, honesty, and ethics in everything we do.

• *Job Summary**

As a Bilingual Customer Service Representative, you'll be the face of arenaflex, handling customer inquiries and resolving issues via phone, internet, or written correspondence. You'll engage with members, providers, and plan sponsors to understand their unique needs and preferences, and you'll educate them on our plans, tools, and resources to help them navigate the healthcare system. This is a 24/7 customer service role, and you'll be required to work any shift, including overnights, weekends, and holidays.

• *Key Responsibilities**

• Answer questions and resolve issues based on phone calls, letters, and emails from members, providers, and plan sponsors.
• Triages resulting rework to appropriate staff and documents and tracks contacts with members, providers, and plan sponsors.
• Guides members through their plan of benefits, Aetna policy, and procedures, and provides knowledge of resources to comply with regulatory guidelines.
• Creates an emotional connection with members by understanding and engaging with them to champion their best health.
• Takes accountability to fully understand members' needs by building trusting and caring relationships.
• Anticipates customer needs and provides related information to answer unasked questions.
• Uses customer service threshold framework to make financial decisions to resolve member issues.
• Explains members' rights and responsibilities in accordance with contract.
• Processes claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via target system.
• Educates providers on self-service options and assists with credentialing and re-credentialing issues.
• Responds to requests from Aetna's Law Document Center regarding litigation and lawsuits.
• Handles extensive file review requests and assists in preparation of complaint trend reports.
• Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility relating to incoming correspondence and internal referrals.
• Handles incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
• Performs review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.

• *Essential Qualifications**

• Bilingual – written and oral fluency in Spanish + English
• High School or GED equivalent
• Ability to work any shift, including overnights, weekends, and holidays
• Strong communication and interpersonal skills
• Ability to multitask and prioritize tasks efficiently
• Proficient with Microsoft Word and Outlook
• Ability to maintain accuracy and production standards
• Negotiation skills
• Technical skills
• Problem-solving skills
• Attention to detail and accuracy
• Analytical skills

• *Preferred Qualifications**

• Customer service experience in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate.
• Experience in a production environment.
• Understanding of medical terminology.
• Proficient oral and written communication skills.
• Ability to maintain a high level of productivity and accuracy in a fast-paced environment.

• *Career Growth Opportunities and Learning Benefits**

At arenaflex, we're committed to helping our employees grow and develop their careers. We offer a range of training programs, mentorship opportunities, and career development resources to help you achieve your goals. Some of the benefits include:

• **Training and Development**: We offer comprehensive training programs to help you develop your skills and knowledge.
• **Mentorship**: We pair you with experienced mentors who can guide and support you in your career.
• **Career Advancement**: We offer opportunities for career advancement and promotion within the company.
• **Education Assistance**: We offer education assistance programs to help you pursue higher education or certifications.
• **Free Development Courses**: We offer free development courses to help you develop your skills and knowledge.

• *Work Environment and Company Culture**

At arenaflex, we're proud of our inclusive and supportive work environment. We believe in creating a workplace that's welcoming, diverse, and inclusive, where everyone feels valued and respected. Some of the benefits include:

• **Flexible Work Arrangements**: We offer flexible work arrangements, including remote work options and flexible hours.
• **Diverse and Inclusive Culture**: We're committed to creating a workplace that's welcoming and inclusive of all employees.
• **Employee Recognition**: We recognize and reward our employees for their hard work and contributions.
• **Wellness Programs**: We offer wellness programs to help you maintain your physical and mental health.
• **Community Involvement**: We're committed to giving back to our communities and supporting local charities and organizations.

• *Compensation, Perks, and Benefits**

At arenaflex, we offer a comprehensive compensation and benefits package that includes:

• **Competitive Salary**: We offer a competitive salary that's based on your experience and qualifications.
• **Medical, Dental, and Vision Benefits**: We offer medical, dental, and vision benefits to help you maintain your health and well-being.
• **401(k) Retirement Savings Plan**: We offer a 401(k) retirement savings plan to help you save for your future.
• **Employee Stock Purchase Plan**: We offer an employee stock purchase plan to help you invest in your future.
• **Paid Time Off**: We offer paid time off, including vacation pay and paid holidays.
• **Discount Programs**: We offer discount programs with participating partners to help you save money.

• *Conclusion**

If you're passionate about delivering exceptional customer experiences and making a meaningful difference in people's lives, we want to hear from you! As a Bilingual Customer Service Representative at arenaflex, you'll have the opportunity to work with a talented team of professionals who share your passion for innovation, excellence, and compassion. Apply now to join our team and start making a difference in the lives of our members, providers, and plan sponsors!