**Experienced Customer Service Representative – Work from Home Opportunity in EST/PST Time Zones**

At arenaflex, we're dedicated to delivering exceptional customer experiences that make a meaningful difference in people's lives. As a Customer Service Representative, you'll be the face of arenaflex, impacting members' service experiences through your manner of handling customer service inquiries and problems via telephone, internet, or written correspondence. If you're passionate about providing empathetic and compassionate service, we want to hear from you.

• *About arenaflex**

arenaflex is a leading healthcare company that shares a single, clear purpose: Bringing our heart to every moment of your health. Our purpose guides our commitment to deliver enhanced human-centric healthcare for a rapidly changing world. Anchored in our brand — with heart at its center — our purpose sends a personal message that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose, empowering everyone who works at arenaflex to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions to make healthcare more personal, convenient, and affordable.

• *Job Summary**

We're seeking an experienced Customer Service Representative to join our team in a permanent work-from-home (WFH) arrangement for candidates in the east and west coast time zones. As a Customer Service Representative, you'll be responsible for handling customer inquiries and resolving issues in a timely and professional manner. You'll engage, consult, and educate members based on their unique needs, preferences, and understanding of arenaflex plans, tools, and resources to guide them along a clear path to care.

• *Key Responsibilities**

• Handle customer inquiries and resolve issues via telephone, internet, or written correspondence
• Engage, consult, and educate members based on their unique needs, preferences, and understanding of arenaflex plans, tools, and resources
• Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors
• Triage resulting rework to appropriate staff
• Document and track contacts with members, providers, and plan sponsors
• Guide members through their plan of benefits, arenaflex policy, and procedures, as well as provide knowledge of resources to comply with regulatory guidelines
• Create an emotional connection with members by understanding and engaging them to champion for their best health
• Take accountability to fully understand members' needs by building a trusting and caring relationship with them
• Anticipate customer needs and provide related information to answer unasked questions
• Use customer service threshold framework to make financial decisions to resolve member issues
• Explain members' 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 providers on self-service options and assist with credentialing and re-credentialing issues
• Respond to requests received from arenaflex's Law Document Center regarding litigation; lawsuits
• Handle extensive file review requests
• Assist in preparation of complaint trend reports
• 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
• Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management
• Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible
• Perform financial data maintenance as necessary

• *Essential 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
• High school education or GED equivalent

• *Preferred Qualifications**

• Experience in a healthcare or insurance industry
• Knowledge of healthcare plans, tools, and resources
• Familiarity with regulatory guidelines and compliance
• Experience with customer service threshold framework and financial decision-making

• *Skills and Competencies**

• Excellent communication and interpersonal skills
• Ability to work in a fast-paced environment and prioritize tasks effectively
• Strong problem-solving and analytical skills
• Ability to work independently and as part of a team
• Proficiency in Microsoft Office and other software applications
• Strong attention to detail and organizational skills

• *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 and development programs, including:

• On-the-job training and coaching
• Online courses and webinars
• Mentorship programs
• Leadership development opportunities
• Career advancement opportunities

• *Work Environment and Company Culture**

As a work-from-home employee, you'll have the flexibility to work from the comfort of your own home. Our company culture is built on our Heart At Work Behaviors, which include:

• Empathy and compassion
• Collaboration and teamwork
• Innovation and creativity
• Accountability and ownership
• Continuous learning and development

• *Compensation, Perks, and Benefits**

We offer a competitive compensation package, including:

• Hourly rate: $17.00 - $25.65
• Benefits package, including medical, dental, and vision insurance
• 401(k) retirement savings plan
• Employee Stock Purchase Plan
• Fully-paid term life insurance plan
• Short-term and long-term disability benefits
• Paid Time Off (PTO) or vacation pay
• Paid holidays throughout the calendar year
• Number of paid holidays, sick time, and other time off consistent with relevant state law and company policies

• *How to Apply**

If you're passionate about delivering exceptional customer experiences and are looking for a challenging and rewarding career opportunity, we encourage you to apply. Please visit our website at jobs.arenaflex.com to submit your application. The application window for this opening will close on September 9, 2024.

• *Equal Employment Opportunity**

arenaflex is an equal employment opportunity employer and welcomes applications from diverse candidates. Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws.