Experienced Customer Service and Claims Representative – National Remote Healthcare Support Specialist

Join arenaflex and Make a Meaningful Impact on Healthcare Every Single Day

Are you a compassionate, driven professional who thrives on helping others navigate complex situations? Do you have a passion for delivering exceptional customer service while working in a fast-paced, mission-driven environment? arenaflex is looking for dedicated individuals to join our team as Customer Service and Claims Representatives in a fully remote, national capacity. This is your opportunity to build a rewarding career with a company that genuinely cares about its employees, its members, and the broader healthcare landscape.

At arenaflex, we believe that what you do matters. We are a leading organization committed to transforming the healthcare experience by providing consumer-oriented health benefit plans to millions of people across the nation. Our mission is clear: to create higher quality care, lower costs, and greater access to healthcare for everyone. When you join our team, you become part of an innovative organization that is reshaping the way Americans experience healthcare. The opportunities for professional growth and career advancement within arenaflex are truly endless, particularly as we continue our record-breaking expansion throughout the industry.

About the Role

As a Customer Service and Claims Representative at arenaflex, you will serve in a dual-capacity role that combines inbound customer service with healthcare claims processing. You will be the first point of contact for our members, helping them understand their benefits, resolve inquiries, and navigate the often-complex world of health insurance. Every call you answer and every claim you process represents an opportunity to improve someone's healthcare experience and exceed their expectations.

This is a full-time position requiring 40 hours per week, Monday through Friday. Employees must have flexibility to work any of our 8-hour shift schedules during our normal business hours of 8:00 AM to 4:30 PM CST. Regardless of your time zone, you will be expected to work during these core hours. Occasional overtime may be required based on business needs. We provide comprehensive paid on-the-job training to ensure you feel confident and supported from day one.

Key Responsibilities

• Customer Interaction Excellence: Answer incoming phone calls from customers and identify the type of assistance each caller needs, whether that involves benefits and eligibility questions, billing and payment inquiries, treatment authorizations, or explanation of benefits (EOBs).
• Active Listening and Documentation: Ask appropriate questions and listen actively to identify specific concerns while carefully documenting all required information in our computer systems.
• Problem Resolution: Take ownership of customer issues and see them through to resolution, whether that occurs in real time during the call or through comprehensive and timely follow-up communication with the member.
• Claims Review and Research: Review and research incoming healthcare claims from members and providers, including doctors and clinics. Navigate multiple computer systems and platforms to verify data and information necessary for processing, such as pricing, prior authorizations, and applicable benefits.
• Benefits Application: Ensure that proper benefits are applied to each claim by following appropriate processes and procedures, including claims processing policies, grievance procedures, state mandates, CMS/Medicare guidelines, benefit plans, and certificates of coverage.
• Clear Communication: Communicate and collaborate with members and providers to resolve issues, using clear, simple language that ensures understanding of complex healthcare processes.
• Performance Achievement: Meet established performance goals in the areas of efficiency, accuracy, quality, member satisfaction, and attendance.

Required Qualifications

• High School Diploma or GED, or equivalent work experience
• Minimum of 1 year of experience in a call center environment
• Minimum of 1 year of customer service experience
• Previous experience working in the healthcare and health insurance industry
• Working knowledge of medical terminology
• Experience working in a metric-driven work environment where performance is measured regularly
• Flexibility to work any 8-hour shift between 8:00 AM and 4:30 PM CST, Monday through Friday, including the ability to work occasional overtime as business needs dictate
• Must be 18 years of age or older

Telecommuting Requirements

As a remote employee, you will be required to adhere to arenaflex's Telecommuter Policy. This includes:

• Ability to keep all company-sensitive documents secure
• Maintaining a dedicated work area that is separated from other living areas and provides information privacy
• Living in a location that can receive a high-speed internet connection approved by arenaflex, or having access to an existing reliable high-speed internet service

Essential Skills and Competencies

Success in this role requires a unique blend of interpersonal skills, technical aptitude, and professional resilience. We are looking for candidates who demonstrate:

• Rapport Building: The ability to quickly build rapport and respond to customers in a compassionate manner by identifying and exceeding their expectations, responding in a respectful and timely fashion, and consistently meeting commitments.
• Active Listening: Demonstrated ability to listen skillfully, collect relevant information, determine immediate requests, and identify both current and future needs of the member.
• Problem-Solving: A proficient problem-solving approach that allows you to quickly assess the current state of any situation and formulate effective recommendations.
• Simplified Communication: The ability to translate healthcare-related jargon and complex processes into simple, step-by-step instructions that customers can easily understand and act upon.
• Adaptability: Flexibility to customize your approach to meet all types of member communication styles and personalities.
• Conflict Management: Proficient conflict management skills, including the ability to resolve issues in stressful situations while demonstrating personal resilience.
• Schedule Flexibility: Ability to work regularly scheduled shifts within our hours of operation, including the training period, with the flexibility to adjust daily schedules and work overtime or weekends as needed.

What We Offer

At arenaflex, we believe in rewarding our employees for their hard work and dedication. We provide a comprehensive compensation and benefits package designed to support your professional growth, financial security, and overall well-being.

For residents of California, Colorado, Connecticut, Hawaii, Nevada, New Jersey, New York, Washington, and Rhode Island, the hourly range for this position is $16.00 to $28.27 per hour. Pay is based on several factors, including local labor markets, education, work experience, and certifications. arenaflex complies with all minimum wage laws as applicable.

In addition to competitive base pay, arenaflex offers an impressive benefits package that may include:

• Comprehensive medical, dental, and vision coverage
• Incentive and recognition programs that celebrate your achievements
• Equity stock purchase opportunities
• 401(k) retirement plan with company contribution
• Paid time off and holiday pay
• Professional development and career advancement opportunities
• Wellness programs and employee assistance resources

Please note that all benefits are subject to eligibility requirements. No matter where or when you begin your career with arenaflex, you will discover a far-reaching selection of benefits and incentives designed to support your success.

Our Commitment to Diversity, Equity, and Inclusion

At arenaflex, our mission extends beyond providing excellent healthcare services. We are committed to helping people live healthier lives and making the healthcare system work better for everyone. We firmly believe that everyone—regardless of race, gender, sexuality, age, location, or income—deserves the opportunity to live their healthiest life.

We recognize that significant barriers to good health still exist, and these barriers disproportionately impact people of color, historically marginalized groups, and those with lower incomes. arenaflex is committed to mitigating our environmental impact, enabling and delivering equitable care, addressing health disparities, and improving health outcomes for all communities. This commitment is reflected in everything we do.

Diversity creates a healthier atmosphere, and arenaflex is proud to be an Equal Employment Opportunity and Affirmative Action employer. 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 applicable law.

arenaflex maintains a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Why This Opportunity Is Different

This is more than just a customer service job. This is your chance to combine your natural compassion for others with your professional expertise in a role that truly makes a difference. At arenaflex, you will receive the support, training, and development you need to ensure your success. You will work alongside dedicated professionals who share your commitment to excellence and your passion for helping others.

We provide the structure and support; you bring the interest, motivation, and heart. Together, we will continue to raise the bar for what exceptional customer service looks like in the healthcare industry. This is no small opportunity. This is where you can bring your compassion for others while doing your life's best work.

Take the Next Step in Your Career

If you are ready to join a team that values your contributions, supports your growth, and empowers you to achieve new levels of excellence, we encourage you to apply today. Training classes are starting soon, and we want you to be part of our next cohort of talented professionals.

Your career journey with arenaflex begins with a single step. Take that step today and discover where your skills, compassion, and ambition can take you. We look forward to welcoming you to the arenaflex family.