Experienced Healthcare Customer Service Representative – Policy Management, Benefits, and Claims
Join arenaflex, a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide, as a valued member of our team. As a Healthcare Customer Service Representative, you will play a crucial role in taking member services calls in relation to policy management, benefits, and claim inquiries. Your exceptional customer service skills and expertise in healthcare terminology will ensure the satisfaction of our clients and members.
About arenaflex
arenaflex is a mission-critical partner to healthcare plans nationwide, providing claims processing services, including digital transformation, claims adjudication, and member and provider engagement services. With a strong presence in the industry, arenaflex serves over 70 health plans and processes millions of claims annually. Our innovative workflow technology platform, JetStreamTM, helps clients achieve traceability, governance, and automation of claims operations.
Job Type and Schedule
This is a full-time, 100% remote position with a shifting schedule, Monday through Friday, 7:00am to 7:00pm MT/9:00am to 9:00pm EST/8:00am to 8:00pm CT. Weekends may be required, and you will be expected to work independently and collaboratively within a team environment.
Pay and Benefits
* Competitive hourly rate: $17.00 - $19.00 per hour, depending on experience
- Paid training period
- Comprehensive benefits package, including medical, dental, life, vision, and HSA after 30 days
- 7 paid holidays (no waiting period)
- 6 PTO days and 401K after 90 days
- Equipment provided
Key Responsibilities
As a Healthcare Customer Service Representative, you will be responsible for:
- Policy Management:
+ Billing: Process member payments, address billing inquiries, and resolve billing discrepancies. + Member Information Updates: Update member information accurately and promptly, including addresses, phone numbers, beneficiaries, and employment details. + Policy Terminations and Reinstatements: Handle policy termination requests, process policy terminations effectively, and assist with policy reinstatements. + ID Card Ordering: Process ID card orders efficiently, ensure timely delivery, and address any ID card-related concerns.
- Benefits:
+ Coverage Information: Provide accurate and up-to-date information about coverage plans, including eligibility, benefits, limitations, and exclusions. + Prior Authorization and Referrals: Assist members with prior authorization and referral processes, guiding them through the procedures and requirements. + Healthcare Provider Contact Research: Conduct thorough research to locate contact information for healthcare providers, ensuring accurate and up-to-date information for members.
- Claims:
+ Claims Status Updates: Provide accurate and timely status updates on claims, explaining the processing stages and addressing any concerns. + Claims Inquiries: Answer questions about claim processing, explaining claim denials, and providing guidance on submitting appeals. + Claims Reconsideration Requests: Assist members with reconsideration requests for denied claims, gathering necessary documentation, and supporting their appeals.
- General Inquiry:
+ Website Troubleshooting: Assist members with troubleshooting issues related to the member website, guiding them through navigation and resolving technical problems. + General Questions: Answer general questions about health insurance plans, providing comprehensive and accurate information on various topics.
Additional Responsibilities
* Maintain Confidentiality: Adhere strictly to confidentiality policies and safeguard sensitive member information.
- Escalate Complex Issues: Escalate complex issues to supervisors or managers for further assistance and resolution.
- Continuous Learning: Stay updated on changes in health insurance regulations, policies, and procedures.
- Contribute to Team Success: Collaborate effectively with team members to achieve shared goals and maintain a positive work environment.
Preferred Experience
* Comprehensive knowledge of healthcare industry practices, including: + Medical terminology + Eligibility and benefits verification + Medical claims processing + ICD-9 and ICD-10 coding + Policy and procedural workflows
- Proficient in computer operations, including data entry, screen navigation, and keyboarding
- Demonstrated excellence in customer service and client interaction
- Strong adherence to daily schedules, tasks, and performance metrics
- Ability to multitask effectively while maintaining high attention to detail
- Self-motivated, well-organized, and skilled in time management and problem-solving
Requirements
* High School Diploma or GED required
- Excellent verbal communication skills
- Minimum of 2 years of experience in one or more of the following areas:
+ Claims examination + Health Insurance + Customer Service or Call Center + Medical office or other healthcare-related fields
- Proven experience in customer service related to claims processing, billing, or similar functions
- Must successfully pass a criminal background check
Work from Home Requirements
* High-speed internet of 25MBPS download and 5MBPS upload
- Ability to directly hardwire to your modem
- Quiet dedicated work area
Why Join arenaflex?
* Opportunity to work with a leading provider of back-office support technology and tech-enabled outsourced services to healthcare plans nationwide
- Comprehensive benefits package and competitive hourly rate
- Collaborative and dynamic work environment
- Continuous learning and professional growth opportunities
- Chance to make a difference in the lives of our clients and members
How to Apply
If you are a motivated and customer-focused individual with a passion for healthcare, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, to [insert contact information]. We look forward to hearing from you! Apply for this job