At arenaflex, we're dedicated to delivering exceptional customer experiences that make a meaningful difference in people's lives. As a Customer Service Representative - Federal FFS, you'll play a vital role in shaping the way we interact with our members, providers, and plan sponsors. If you're passionate about providing top-notch service, navigating complex issues, and building lasting relationships, we want to hear from you.
**About arenaflex**
arenaflex is a leading healthcare company that's committed to transforming the way we deliver care. Our purpose is to bring our heart to every moment of your health, and we're driven by a passion for innovation, collaboration, and customer-centricity. With a focus on human-centric healthcare, we're dedicated to making healthcare more personal, convenient, and affordable.
**Our Heart At Work Behaviors**
At arenaflex, we believe that our Heart At Work Behaviors are the foundation of our success. These behaviors support our purpose and guide our actions, ensuring that we deliver exceptional service and care to our members, providers, and plan sponsors. Our Heart At Work Behaviors include:
* **Empathy**: We understand and acknowledge the needs and feelings of our members, providers, and plan sponsors.
* **Collaboration**: We work together as a team to achieve our goals and deliver exceptional service.
* **Innovation**: We're committed to finding new and better ways to deliver care and improve the customer experience.
* **Accountability**: We take ownership of our actions and decisions, ensuring that we deliver on our promises.
* **Respect**: We treat everyone with dignity and respect, valuing their unique perspectives and experiences.
**Job Summary**
As a Customer Service Representative - Federal FFS, you'll be the face of arenaflex, interacting with members, providers, and plan sponsors via phone, internet, or written correspondence. You'll be responsible for handling customer inquiries and resolving issues in a timely and professional manner. Your goal will be to build trust and rapport with our members, providing them with the information and support they need to navigate our plans and resources.
**Key Responsibilities**
* Handle customer inquiries and resolve issues via phone, internet, or written correspondence.
* Engage with members, providers, and plan sponsors to understand their unique needs and preferences.
* Educate members on our plans, tools, and resources, guiding them along a clear path to care.
* 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, Aetna policy and procedures, and resources to comply with regulatory guidelines.
* Create an emotional connection with our members by understanding and engaging with them to champion their best health.
* Take accountability to fully understand the member's needs by building a trusting and caring relationship with the member.
* 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 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 providers on our self-service options; Assist providers 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.
* Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
**Essential Qualifications**
* High School or GED equivalent.
* Customer Service experience in a transaction-based environment, such as a call center, demonstrating ability to be empathetic and compassionate.
* Experience in a production environment.
* Ability to commute on-site to High Point, NC office 5 days per week during first 8 weeks of initial training. Team will transition to full-time work from home following training.
**Preferred Qualifications**
* Medical Terminology and/or Provider office experience.
* Understanding of insurance concepts and processes.
**Skills and Competencies**
* Excellent communication and interpersonal skills.
* Ability to work in a fast-paced environment and prioritize multiple tasks.
* Strong problem-solving and analytical skills.
* Ability to work independently and as part of a team.
* Strong customer service skills, with a focus on empathy and compassion.
* Ability to navigate complex issues and provide clear, concise solutions.
* Strong organizational and time management skills.
* Ability to work in a dynamic environment and adapt to changing priorities.
**Career Growth Opportunities and Learning Benefits**
At arenaflex, we're committed to helping you grow and develop your skills and career. We offer a range of training programs, mentorship opportunities, and career development resources to support your success. Some of the benefits you can expect include:
* Ongoing training and development opportunities to enhance your skills and knowledge.
* Mentorship programs to support your career growth and development.
* Opportunities to take on new challenges and responsibilities.
* A collaborative and supportive work environment that encourages innovation and creativity.
* A comprehensive benefits package, including medical, dental, and vision benefits, as well as a 401(k) retirement savings plan and Employee Stock Purchase Plan.
**Work Environment and Company Culture**
At arenaflex, we're proud of our inclusive and supportive work environment. We believe in fostering a culture of respect, empathy, and collaboration, where everyone feels valued and empowered to contribute. Some of the benefits of working at arenaflex include:
* A dynamic and fast-paced work environment that's always evolving.
* A collaborative and supportive team that's passionate about delivering exceptional service.
* Opportunities to make a meaningful difference in people's lives.
* A comprehensive benefits package that supports your physical, emotional, and financial well-being.
* A commitment to diversity, equity, and inclusion, with a focus on creating a workplace that's welcoming and inclusive for everyone.
**Compensation, Perks, and Benefits**
At arenaflex, we're committed to providing a competitive compensation package that reflects your skills, experience, and contributions. Some of the benefits you can expect include:
* A base hourly rate or base annual full-time salary that's competitive with industry standards.
* Opportunities for bonuses and incentives based on performance.
* A comprehensive benefits package, including medical, dental, and vision benefits, as well as a 401(k) retirement savings plan and Employee Stock Purchase Plan.
* Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year.
* A fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits.
* Numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners.
**Conclusion**
If you're passionate about delivering exceptional customer service and making a meaningful difference in people's lives, we want to hear from you. As a Customer Service Representative - Federal FFS at arenaflex, you'll have the opportunity to work in a dynamic and fast-paced environment, build lasting relationships with our members, providers, and plan sponsors, and contribute to our mission of transforming the way we deliver care. Apply now to join our team and start making a difference today!