At arenaflex, we're dedicated to delivering exceptional customer experiences that make a lasting impact. As a Senior Customer Service Representative, you'll play a vital role in shaping the way we interact with our members, providers, and plan sponsors. If you're passionate about providing top-notch service, building meaningful relationships, and making a difference in people's lives, we want to hear from you.
**About arenaflex**
arenaflex is a leading healthcare company that's committed to revolutionizing the way we approach health care. With a focus on innovation, compassion, and customer-centricity, we're creating a brighter future for our members, providers, and communities. Our purpose is simple: to bring our heart to every moment of your health. We believe that how we deliver our services is just as important as what we deliver, and that's why we're dedicated to creating a culture that's guided by our Heart At Work Behaviors.
**Job Summary**
We're seeking experienced Senior Customer Service Representatives to join our Meritain Health Call Center team in Phoenix, AZ. As a Senior CSR, you'll be responsible for handling customer inquiries and resolving issues via telephone, internet, or written correspondence. You'll work from home, enjoying a flexible schedule and the opportunity to make a real difference in people's lives.
**Responsibilities**
As a Senior Customer Service Representative, you'll be responsible for:
* Handling customer service inquiries and resolving issues in a timely and professional manner
* Providing accurate and empathetic responses to customer inquiries, including explaining member rights and responsibilities
* Triaging resulting rework to appropriate staff and documenting contacts with members, providers, and plan sponsors
* Guiding members through their plan of benefits, Aetna policy, and procedures, as well as providing knowledge of resources to comply with regulatory guidelines
* Creating an emotional connection with our members by understanding and engaging with them to champion their best health
* Anticipating customer needs and providing related information to answer unasked questions
* Using customer service threshold framework to make financial decisions to resolve member issues
* Processing claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via target system
* Educating providers on our self-service options and assisting with credentialing and re-credentialing issues
* Responding to requests from Aetna's Law Document Center regarding litigation and lawsuits
* Assisting in preparation of complaint trend reports and 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
**Requirements**
To be successful in this role, you'll need:
* 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
* Strong communication and interpersonal skills
* Ability to work independently and as part of a team
* Proficiency in using computer software and systems, including CRM and customer service platforms
* Ability to multitask and prioritize tasks in a fast-paced environment
* Strong problem-solving and analytical skills
* Ability to maintain confidentiality and handle sensitive information
**Preferred Qualifications**
* Experience working in a healthcare or insurance environment
* Knowledge of Aetna policies and procedures
* Experience with CRM and customer service platforms
* Certification in customer service or a related field
**Compensation and Benefits**
As a Senior Customer Service Representative at arenaflex, you'll enjoy a competitive salary, benefits, and perks, including:
* $18.50 - $31.72 per hour (based on experience and qualifications)
* Comprehensive medical, dental, and vision benefits
* 401(k) retirement savings plan and Employee Stock Purchase Plan
* Fully-paid term life insurance plan and short-term and long-term disability benefits
* Paid Time Off (PTO) and paid holidays
* CVS store discount and discount programs with participating partners
* Free development courses and education assistance
* Well-being programs and employee recognition and reward programs
**Work Environment and Culture**
As a work-from-home Senior Customer Service Representative, you'll enjoy a flexible schedule and the opportunity to work in a remote environment. Our culture is guided by our Heart At Work Behaviors, which include:
* Empathy and compassion
* Customer-centricity
* Innovation and creativity
* Collaboration and teamwork
* Accountability and ownership
* Continuous learning and development
**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 of dedicated and compassionate professionals.
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