**Experienced Customer Service and Claims Representative – National Remote Opportunity at arenaflex**

At arenaflex, we're simplifying the healthcare experience, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the healthcare system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us and start doing your life's best work.

As a Customer Service and Claims Representative at arenaflex, you'll have the flexibility to telecommute from anywhere within the U.S. and take on the challenge of delivering exceptional customer service and claims processing expertise. You'll join a team dedicated to helping our members and their families every day, and you'll have the opportunity to make a real difference in their lives.

In this role, you'll play a critical role in creating a quality experience for the callers that you connect with and those that you correspond with. Every interaction gives you the opportunity to improve the lives of our customers and exceed their expectations. You'll spend the majority of your day responding to calls from our members and helping answer questions and resolve issues regarding healthcare eligibility, claims, and payments. You'll also spend a portion of your time reviewing, researching, and processing healthcare claims with the goal of ensuring that every claim has a fair and thorough review.

• *About arenaflex**

arenaflex is a leading healthcare company that's committed to helping people live healthier lives and making the healthcare system work better for everyone. We believe that everyone deserves the opportunity to live their healthiest life, regardless of their background or circumstances. Our mission is to create a healthier atmosphere by promoting diversity, equity, and inclusion in everything we do.

• *Key Responsibilities**

• Answer incoming phone calls from customers and identify the type of assistance the customer needs (i.e. benefit and eligibility, billing and payments, authorizations for treatment, and explanation of benefits (EOBs))
• Ask appropriate questions and listen actively to identify specific questions or issues while documenting required information in computer systems
• Own problems through to resolution on behalf of the customer in real-time or through comprehensive and timely follow-up with the member
• Review and research incoming healthcare claims from members and providers (doctors, clinics, etc.) by navigating multiple computer systems and platforms and verifying the data/information necessary for processing (e.g. pricing, prior authorizations, applicable benefits)
• Ensure that the proper benefits are applied to each claim by using the appropriate processes and procedures (e.g. claims processing policies and procedures, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plan documents/certificates)
• Communicate and collaborate with members and providers to resolve issues, using clear, simple language to ensure understanding
• Meet the performance goals established for the position in the areas of: efficiency, accuracy, quality, member satisfaction, and attendance

• *Essential Qualifications**

• High School Diploma / GED or 10 years of equivalent work experience
• Must be 18 years of age or older
• 2 years of previous or current claims processing experience with arenaflex's claims processing system (UMR CPS)
• 1 year of customer service experience in an office or professional setting
• Ability to complete on-the-job training for this role during their normally scheduled 8-hour shift Monday - Friday between the hours of 7 am-8 pm CST
• Ability to work any of our 8-hour shift schedules during our normal business hours of 7:00am - 7:00pm CST. It may be necessary, given the business need, to work occasional overtime.

• *Preferred Qualifications**

• Familiarity with medical terminology, health plan documents, or benefit plan design
• Prior experience utilizing multiple systems/platforms while on a call with a member

• *Soft Skills**

• Demonstrated ability in using computer and Windows PC applications, which includes strong keyboard and navigation skills and learning new computer programs
• Demonstrated ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding customer expectations (responding in a respectful, timely manner, consistently meeting commitments)
• Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the member
• Flexibility to customize approach to meet all types of member communication styles and personalities
• Proficient problem-solving approach to quickly assess current state and formulate recommendations
• Proficient conflict management skills to include ability to resolve issues in a stressful situation and demonstrate personal resilience
• Ability to multi-task as well as the ability to understand multiple products and multiple levels of benefits within each product
• Ability to work regularly scheduled shifts within our hours of operation including the training period, where lunches and breaks are scheduled, with the flexibility to adjust daily schedule and work over-time as needed

• *Compensation and Benefits**

We offer a comprehensive benefits package, including:

• Competitive hourly rate ($16.54 - $32.55 per hour, depending on location and experience)
• Comprehensive benefits package, including medical, dental, and vision coverage
• Incentive and recognition programs
• Equity stock purchase
• 401(k) contribution
• Paid time off and holidays
• Opportunities for career growth and professional development

• *Diversity, Equity, and Inclusion**

arenaflex is an Equal Employment Opportunity / Affirmative Action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, age, national origin, protected veteran status, disability status, sexual orientation, gender identity or expression, marital status, genetic information, or any other characteristic protected by law.

• *How to Apply**

If you're passionate about delivering exceptional customer service and claims processing expertise, and you're looking for a challenging and rewarding career opportunity, we encourage you to apply for this role. Please submit your application through our website or by clicking the link below.

• *Note:** arenaflex is a drug-free workplace, and all candidates are required to pass a drug test before beginning employment.