**Experienced Senior Customer Service Representative – Work from Home Opportunity at arenaflex**

At arenaflex, we're dedicated to delivering exceptional customer experiences that make a meaningful difference in people's lives. As a Senior Customer Service Representative, you'll play a vital role in helping us achieve our mission of providing personalized, convenient, and affordable healthcare solutions. If you're passionate about delivering outstanding customer service, have a heart for helping others, and are looking for a dynamic work-from-home opportunity, we encourage you to apply for this exciting role. **About arenaflex** arenaflex is a leading healthcare company that's committed to transforming the way healthcare is delivered. With a focus on innovation, empathy, and customer-centricity, we're dedicated to making healthcare more accessible, affordable, and convenient for everyone. Our team of passionate professionals is driven by a shared purpose: to bring our heart to every moment of our customers' health. **Our Heart At Work Behaviors** At arenaflex, we believe that our Heart At Work Behaviors are the foundation of our success. These behaviors are designed to empower our employees to make a meaningful impact in their work and to accelerate our ability to innovate and deliver solutions that make a difference in people's lives. Our Heart At Work Behaviors include: * **Empathy**: We understand and appreciate the perspectives and needs of our customers, colleagues, and partners. * **Collaboration**: We work together as a team to achieve our goals and deliver exceptional results. * **Innovation**: We're committed to exploring new ideas, technologies, and approaches that can help us make a meaningful difference in healthcare. * **Accountability**: We take ownership of our work and our actions, and we're accountable for delivering high-quality results. * **Communication**: We communicate clearly, transparently, and respectfully with our customers, colleagues, and partners. **Job Summary** As a Senior Customer Service Representative, you'll be responsible for providing exceptional customer service to our members, providers, and plan sponsors. You'll handle customer inquiries and problems via telephone, internet, or written correspondence, and you'll work closely with our team to resolve issues and provide solutions that meet our customers' needs. This is a work-from-home position that requires a strong commitment to customer service, a passion for helping others, and a willingness to learn and grow with our team. **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 members through their plan of benefits, Aetna policy and procedures, and provide knowledge of resources to comply with regulatory guidelines. * Create an emotional connection with our members by understanding and engaging with them to champion for their best health. * Take accountability to fully understand the member's needs by building a trusting and caring relationship with the member. * 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 member's 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 arenaflex's Law Document Center regarding litigation; lawsuits Handle extensive file review requests. * Assist in preparation of complaint trend reports. * Assist in compiling 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** * Bachelor's degree in a related field. * Experience in a healthcare setting. * Certification in customer service or a related field. **Skills and Competencies** * Excellent customer service skills, with a focus on empathy, active listening, and problem-solving. * Strong communication and interpersonal skills, with the ability to work effectively with diverse groups of people. * Ability to work in a fast-paced environment, with multiple priorities and deadlines. * Strong analytical and problem-solving skills, with the ability to think critically and make sound decisions. * Ability to work independently and as part of a team, with a focus on collaboration and teamwork. * Strong technical skills, with the ability to learn and use new software and systems. **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: * **Training and Development Programs**: We offer a range of training and development programs that can help you build new skills and advance your career. * **Mentorship and Coaching**: We offer mentorship and coaching programs that can help you develop your skills and achieve your goals. * **Career Advancement Opportunities**: We offer career advancement opportunities that can help you move into new roles and responsibilities. * **Wellness and Self-Care Programs**: We offer wellness and self-care programs that can help you manage stress and maintain your physical and mental health. **Work Environment and Company Culture** At arenaflex, we're committed to creating a work environment that's inclusive, diverse, and supportive. We offer a range of benefits and programs that can help you thrive in your role, including: * **Flexible Work Arrangements**: We offer flexible work arrangements that can help you balance your work and personal life. * **Diverse and Inclusive Culture**: We're committed to creating a culture that's inclusive and diverse, with opportunities for everyone to grow and develop. * **Wellness and Self-Care Programs**: We offer wellness and self-care programs that can help you manage stress and maintain your physical and mental health. * **Recognition and Rewards**: We offer recognition and rewards programs that can help you feel valued and appreciated for your contributions. **Compensation, Perks, and Benefits** At arenaflex, we're committed to offering competitive compensation, perks, and benefits that can help you thrive in your role. We offer: * **Competitive Pay**: We offer competitive pay rates that reflect your skills and experience. * **Benefits Package**: We offer a comprehensive benefits package that includes medical, dental, and vision coverage, as well as 401(k) and other retirement savings plans. * **Perks and Discounts**: We offer a range of perks and discounts that can help you save money and enjoy your work. * **Paid Time Off**: We offer paid time off, including vacation, sick leave, and holidays. **How to Apply** If you're passionate about delivering exceptional customer service and are looking for a dynamic work-from-home opportunity, we encourage you to apply for this exciting role. Please submit your application, including your resume and a cover letter, to [insert contact information]. We look forward to hearing from you! **Equal Employment Opportunity** arenaflex is an equal employment opportunity employer, committed to diversity and inclusion in the workplace. We welcome applications from qualified candidates of all backgrounds and perspectives. Apply for this job