**Job Title:** Customer Service Representative - IL Resident - Transforming Healthcare Experiences at arenaflex

**Job Description:** Join arenaflex's Customer Service Team and Make a Difference in Healthcare At arenaflex, we're revolutionizing the way healthcare is delivered, and we're looking for talented individuals to join our Customer Service team. As a Customer Service Representative, you'll be the face of arenaflex, impacting the lives of millions of Americans by providing exceptional service and support. If you're passionate about transforming healthcare experiences and have a knack for building strong relationships, we want to hear from you! About arenaflex arenaflex is a leading health solutions company that reaches millions of Americans through our local presence, digital channels, and a team of over 300,000 purpose-driven colleagues. We're committed to creating a world of health around every consumer, and we're dedicated to surrounding ourselves with talented individuals who share our passion for transforming healthcare. Position Summary We're currently recruiting top talent for our Center of Excellence Customer Service group. As a Customer Service Representative, you'll be responsible for handling customer inquiries and resolving issues via telephone, internet, or written correspondence. You'll engage with members, providers, and plan sponsors to educate them on Aetna plans, tools, and resources, and guide them along a clear path to care. Responsibilities Handle customer inquiries and resolve issues via telephone, internet, or written correspondence Engage with members, providers, and plan sponsors to educate them on Aetna plans, tools, and resources Guide members along a clear path to care, understanding their unique needs, preferences, and understanding of Aetna plans 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 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 Assist providers 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 Qualifications Required Qualifications 1 year of Customer service experience Must reside in IL Ability to multi-task to accomplish workload efficiently Oral and written communication skills Ability to maintain accuracy and production standards Technical skills Problem-solving skills Attention to detail and accuracy Preferred Qualifications 1 year of healthcare experience 1 year of call center experience Education * High School or GED equivalent Compensation and Benefits * The typical pay range for this role is: $17.00 - $31.30 * Our comprehensive and competitive mix of pay and benefits includes: + Affordable medical plan options + A 401(k) plan (including matching company contributions) + An employee stock purchase plan + No-cost programs for all colleagues, including wellness screenings, tobacco cessation, and weight management programs + Confidential counseling and financial coaching + Benefit solutions that address the different needs and preferences of our colleagues, including paid time off, flexible work schedules, family leave, dependent care resources, colleague assistance programs, tuition assistance, retiree medical access, and many other benefits depending on eligibility Work Environment and Culture * arenaflex is a dynamic and inclusive workplace that values diversity, equity, and inclusion * Our employees are self-disciplined, hard working, curious, trustworthy, humble, and truthful * We're committed to fostering a workplace where every colleague feels valued and that they belong * Our teams reflect the customers, patients, members, and communities we serve Why Join arenaflex? * Make a difference in the lives of millions of Americans by providing exceptional service and support * Be part of a dynamic and inclusive workplace that values diversity, equity, and inclusion * Enjoy a comprehensive and competitive mix of pay and benefits * Develop your skills and career with our extensive training and development programs * Collaborate with a talented team of purpose-driven colleagues who share your passion for transforming healthcare How to Apply If you're passionate about transforming healthcare experiences and have a knack for building strong relationships, we want to hear from you! Apply now to join our Customer Service team at arenaflex. Apply Job! Apply for this job