Join arenaflex, a leading healthcare organization, as a Bilingual Customer Service Representative and play a vital role in delivering exceptional customer experiences to our members. As a key member of our team, you will be the face of arenaflex, impacting members' service experience by handling customer inquiries and resolving issues via telephone, internet, or written correspondence. If you are passionate about providing top-notch customer service, have a strong understanding of medical terminology, and are fluent in both English and Spanish, we encourage you to apply for this exciting opportunity.
**About arenaflex**
arenaflex is a dynamic and innovative healthcare organization that is committed to delivering enhanced human-centric healthcare for a rapidly changing world. Our purpose is to bring our heart to every moment of our members' health, and we strive to create a culture that is centered around empathy, compassion, and innovation. At arenaflex, we believe that every individual has the potential to make a meaningful impact, and we are dedicated to empowering our employees to accelerate our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable.
**Our Heart At Work Behaviors**
Our Heart At Work Behaviors support our purpose and are the foundation of our culture. We want every employee to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions. Our Heart At Work Behaviors include:
* **Empathy**: We understand and share the feelings of others.
* **Compassion**: We care deeply about the well-being of others.
* **Innovation**: We are curious, creative, and open to new ideas.
* **Collaboration**: We work together to achieve a common goal.
* **Accountability**: We take ownership of our actions and their impact.
**Key Responsibilities**
As a Bilingual Customer Service Representative, you will be responsible for:
* Answering questions and resolving issues based on phone calls/letters from members, providers, and plan sponsors.
* Triaging resulting rework to appropriate staff.
* Documenting and tracking contacts with members, providers, and plan sponsors.
* Guiding members through their plan of benefits, arenaflex policy and procedures, and having knowledge of resources to comply with regulatory guidelines.
* Creating an emotional connection with our members by understanding and engaging the member to the fullest to champion for our members' best health.
* Taking accountability to fully understand the member's needs by building a trusting and caring relationship with the member.
* Anticipating customer needs and providing related information to answer unasked questions.
* Using customer service threshold framework to make financial decisions to resolve member issues.
* Explaining member's rights and responsibilities in accordance with contract.
* Processing claim referrals, new claim handoffs, nurse reviews, complaints (member/provider), grievance, and appeals (member/provider) via target system.
* Educating providers on our self-service options; Assisting providers with credentialing and re-credentialing issues.
* Responding to requests received from arenaflex's Law Document Center regarding litigation; lawsuits Handles extensive file review requests.
* Assisting in preparation of complaint trend reports. Assisting in compiling claim data for customer audits.
* Determining medical necessity, applicable coverage provisions, and verifying member plan eligibility relating to incoming correspondence and internal referrals.
* Handling incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management.
* Performing review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible.
* Performing financial data maintenance as necessary.
* Using applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received.
**Essential and Preferred Qualifications**
* Bilingual - written and oral fluency in Spanish + English
* Customer Service experiences in a transaction-based environment such as a call center or retail location preferred, demonstrating ability to be empathetic and compassionate.
* Ability to multi-task to accomplish workload efficiently.
* Understanding of medical terminology.
* Proficient oral and written communication skills.
* Proficient with Microsoft Word and Outlook.
* Ability to maintain accuracy and production standards.
* Negotiation skills.
* Technical skills.
* Problem-solving skills.
* Attention to detail and accuracy.
* Analytical skills
**Education**
High School or GED equivalent.
**Pay Range**
The typical pay range for this role is:
$17.00 - $29.88
This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography, and other relevant factors.
**Benefits**
In addition to your compensation, enjoy the rewards of an organization that puts our heart into caring for our colleagues and our communities. arenaflex offers a full range of medical, dental, and vision benefits. Eligible employees may enroll in the Company's 401(k) retirement savings plan, and an Employee Stock Purchase Plan is also available for eligible employees. arenaflex provides a fully-paid term life insurance plan to eligible employees, and short-term and long-term disability benefits. arenaflex also offers numerous well-being programs, education assistance, free development courses, a CVS store discount, and discount programs with participating partners. As for time off, arenaflex employees enjoy Paid Time Off (PTO) or vacation pay, as well as paid holidays throughout the calendar year. Number of paid holidays, sick time, and other time off are provided consistent with relevant state law and Company policies.
**Career Growth Opportunities and Learning Benefits**
arenaflex is committed to the growth and development of our employees. We offer a range of training programs, mentorship opportunities, and career advancement possibilities. Our employees have the opportunity to work on challenging projects, develop new skills, and take on new responsibilities. We also offer a range of benefits to support our employees' well-being, including access to mental health resources, employee assistance programs, and wellness initiatives.
**Work Environment and Company Culture**
arenaflex is a dynamic and innovative organization that is committed to delivering exceptional customer experiences. Our work environment is fast-paced and challenging, with a focus on teamwork, collaboration, and continuous improvement. We are a remote-friendly organization, with many employees working from home or in our offices. Our company culture is centered around empathy, compassion, and innovation, and we strive to create a workplace that is inclusive, diverse, and supportive.
**How to Apply**
If you are a motivated and customer-focused individual who is passionate about delivering exceptional customer experiences, we encourage you to apply for this exciting opportunity. Please visit our website to learn more about arenaflex and to submit your application. We look forward to hearing from you!