**Job Summary:**
Join arenaflex, a leading healthcare company, as an Experienced Customer Service Representative in a work-from-home setting. As a key member of our team, you will be responsible for delivering exceptional customer service, resolving customer complaints, and processing orders and modifications across various communication channels. If you have a passion for helping others, are highly organized, and possess excellent communication skills, we encourage you to apply for this exciting opportunity.
**About arenaflex:**
At arenaflex, we are committed to bringing our heart to every moment of your health. Our purpose is to deliver enhanced human-centric healthcare for a rapidly changing world. We believe that how we deliver our services is just as important as what we deliver. Our Heart At Work Behaviors support this purpose, empowering our employees 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.
**Responsibilities:**
As an Experienced Customer Service Representative, you will be responsible for:
* Maintaining a positive, empathetic, and professional attitude toward customers at all times
* Responding promptly to customer inquiries
* Communicating with customers through various channels, including phone, email, and chat
* Acknowledging and resolving customer complaints in a timely and professional manner
* Knowing our products and services inside and out to answer customer questions
* Processing orders, forms, applications, and requests
* Keeping records of customer interactions, transactions, comments, and complaints
* Communicating and coordinating with colleagues as necessary
* Providing feedback on the efficiency of the customer service process
* Managing a team of junior customer service representatives (in the future)
**Key Responsibilities:**
* Answer questions and resolve issues based on phone calls/letters from members, providers, and plan sponsors
* Triages resulting rework to appropriate staff
* Provide excellent customer services for high-volume inbound provider calls for the Claims Inquiry/Claims Research team
* Extensive claims research on multiple platforms to assist providers with payment questions
* Provides the customer with related information to answer unasked questions, e.g., additional plan details, benefit plan details, member self-service tools, etc.
* Uses customer service threshold framework to make financial decisions to resolve member issues
* Explains member's rights and responsibilities in accordance with contract
* Processes claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance, and appeals (member/provider) via target system
* Educates & assists providers on our self-service options
* Assists providers with credentialing and re-credentialing and contracting questions and issues
* Assists in compiling claim data for customer audits
* Determines medical necessity, applicable coverage provisions, and verifies member plan eligibility relating to incoming correspondence and internal referrals
**Requirements:**
* Must live in the state of Oklahoma full-time
* Familiarity with Microsoft Office products
* Experience in highly transactional call center environment
* Excellent customer service and critical thinking
* High-speed internet access (25 mbps or higher) and consistent connection
* Work location must be set up with a direct connection to the router (NOT Wi-Fi)
* We provide a 6 ½ foot long ethernet cord, if the distance is further, you will be required to provide your own ethernet cable
**Education:**
* High School diploma or GED equivalent
**Work Schedule:**
* This is a work-from-home position, and you must be available to work a Monday-Friday schedule
* The permanent schedule can start as early as 7 am CST and end as late as 7 pm CST
* Must be able to attend 4 weeks of virtual training between the hours of 8-5 CST
**Benefits:**
* Competitive salary and benefits package
* Opportunity to work from home and enjoy a better work-life balance
* Comprehensive training program to ensure your success in the role
* Collaborative and supportive team environment
* Opportunities for career growth and professional development
* Recognition and rewards for outstanding performance
**How to Apply:**
If you are a motivated and customer-focused individual who is passionate about delivering exceptional service, we encourage you to apply for this exciting opportunity. Please submit your application through our website, and we will review your qualifications and experience.
**Equal Employment Opportunity:**
arenaflex is an equal employment opportunity employer and welcomes applications from diverse candidates. We are committed to creating an inclusive and respectful work environment that values diversity and promotes equal opportunities for all employees.
**Contact Us:**
If you have any questions or would like to learn more about this opportunity, please contact our HR team at [insert contact information]. We look forward to hearing from you!