At arenaflex, we're dedicated to delivering exceptional healthcare experiences that put our customers at the heart of everything we do. As a Customer Service Representative, you'll play a vital role in transforming our culture and accelerating our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable.
**About arenaflex**
arenaflex is a leading healthcare company that's committed to putting our heart into every moment of our customers' health. Our purpose is to deliver enhanced human-centric healthcare for a rapidly changing world, and we're anchored in our brand with heart at its center. We believe that how we deliver our services is just as important as what we deliver, and we're passionate about creating a culture that's driven by empathy, compassion, and a commitment to excellence.
**Our Heart At Work Behaviors**
Our Heart At Work Behaviors support our purpose and guide our commitment to delivering exceptional customer experiences. We want 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 that make healthcare more personal, convenient, and affordable.
**Position Summary**
We're seeking experienced Customer Service Representatives to join our team in Buffalo, NY. As a Customer Service Representative, you'll be responsible for handling customer service inquiries and problems via telephone, internet, or written correspondence. You'll work closely with our customers to understand their needs and provide solutions that meet their expectations.
**Key Responsibilities**
* Handle customer service inquiries and problems via telephone, internet, or written correspondence
* 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 customers through their plan of benefits, Aetna policy, and procedures
* Provide emotional connections with customers by understanding and engaging them to the fullest
* 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 customers' 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 and assist with credentialing and re-credentialing issues
* Respond to requests received from Aetna's Law Document Center regarding litigation and lawsuits
* Assist in preparation of complaint trend reports and compile 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**
* 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 diploma, GED, or equivalent experience
**Preferred Qualifications**
* Experience in a healthcare setting
* Knowledge of healthcare policies and procedures
* Experience with customer relationship management (CRM) software
**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
* Strong customer service skills and ability to build relationships with customers
* Knowledge of healthcare policies and procedures
* Experience with CRM software
**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 learning and development opportunities, including:
* On-the-job training and mentorship
* Professional development courses and workshops
* Leadership development programs
* Career advancement opportunities
**Work Environment and Company Culture**
We're proud of our company culture, which is built on our Heart At Work Behaviors. We believe in creating a workplace that's inclusive, diverse, and supportive, where everyone feels valued and empowered to contribute their best work. Our office is located in Buffalo, NY, and we offer a range of benefits and perks, including:
* Competitive salary and bonus structure
* Comprehensive benefits package, including medical, dental, and vision insurance
* 401(k) retirement savings plan and employee stock purchase plan
* Paid time off and holidays
* Flexible work arrangements and remote work options
* Access to our on-site fitness center and wellness programs
* Discounts on arenaflex products and services
**Compensation, Perks, and Benefits**
We offer a competitive salary and bonus structure, as well as a range of benefits and perks, including:
* Competitive salary: $17.50/hour
* Bonus structure: eligible for a CVS Health bonus, commission, or short-term incentive program
* Comprehensive benefits package: medical, dental, and vision insurance
* 401(k) retirement savings plan and employee stock purchase plan
* Paid time off and holidays
* Flexible work arrangements and remote work options
* Access to our on-site fitness center and wellness programs
* Discounts on arenaflex products and services
**How to Apply**
If you're passionate about delivering exceptional customer experiences and making a difference in people's lives, we want to hear from you. Apply now to join our team as a Customer Service Representative and be part of a company that's putting its heart into every moment of our customers' health.
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