Job Description
At arenaflex, we're revolutionizing the way people interact with healthcare, creating healthier communities, and removing barriers to quality care. The work you do here impacts the lives of millions of people for the better. Come build the healthcare system of tomorrow, making it more responsive, affordable, and equitable. Ready to make a difference? Join us to start Caring. Connecting. Growing together.
- *Job Summary:**
As an Experienced Premier Customer Service Advocate at arenaflex, you'll be responsible for building trust with members across their healthcare lifecycle. This role is a critical part of our team, assisting members with medical and pharmacy benefits, eligibility, claim resolution, triaging dental and vision issues, and improving healthcare literacy. You'll be the single point of contact for members, providing end-to-end resolution for their inquiries and issues. If you're passionate about delivering exceptional customer service, have a strong understanding of healthcare, and are eager to make a difference, we want to hear from you.
- *Key Responsibilities:**
- Provide premium level service, removing burdens and providing end-to-end resolution for members. This includes, but is not limited to: + Clinical, Financial Decision Support, Behavioral Support, Claims inquiries, and more+ Single point of contact for the member for highly designated or dedicated arenaflex national or key account insurance plans+ Respond to and own consumer inquiries and issues by identifying the topic and type of assistance the caller needs such as benefits, eligibility, claims, financial spending accounts, correspondence, OptumRx, Pharmacy, Optum Behavioral Health, and self-service options+ Own problem through to resolution on behalf of the member in real time or through comprehensive and timely follow-up with the member+ Educate members about the fundamentals and benefits of consumer-driven healthcare topics to include managing their health and well-being so they can select the best benefit plan options and maximize the value of their health plan benefits+ Advocate and intervene with care providers (doctor's offices) on behalf of the member to assist with appointment scheduling, billing concerns, and coverage determinations+ Assist the member with resolution as their advocate with 3rd party vendors+ Assist members in navigating myuhc.com and other arenaflex websites or applications utilizing remote desktop system capabilities+ Communicate and keep consumer informed through the means in which they prefer, i.e. Phone Call, secure messaging, e-mail or chat+ Research complex issues across multiple databases and work with support resources to resolve member issues and/or partner with others to resolve escalated issues
- Meet the performance goals established for the position in the areas of: conversation effectiveness, call quality, member satisfaction, first call resolution, efficiency, and attendance
- Answer up to 30 to 60 incoming calls per day from members of our health / dental / vision / pharmacy plans
- Perform claims adjustments/dollar payments to providers and/or members ultimately impacting arenaflex costs or commercial account costs
- Effectively refer and enroll members to appropriate internal specialists and programs, based on member's needs and eligibility using multiple databases
- Interpret and translate clinical / medical terminology into simple-to-understand terms for members
- Respond to and resolve on the first call, member service inquires and issues by identifying the topic and type of assistance the caller needs, such as; benefits, eligibility and claims, financial spending accounts and correspondence
- Navigate through multiple platforms and databases to retrieve information regarding medical plans, prescription plans, flexible spending accounts, health reimbursement accounts, vision plans, dental plans, employer-based reward plans, claims submissions, clinical programs, etc.
- Must remain current on all communicated changes in process and policies / guidelines. Adapt to all process changes quickly, and maintain knowledge of changes at site level and entity level by utilizing all available resources
- *Additional Responsibilities:**
- Resolve member service inquiries related to: + Medical benefits, eligibility, and claims+ Terminology and plan design+ Financial spending accounts+ Pharmacy benefits, eligibility, and claims+ Correspondence requests+ Educate members about the fundamentals of healthcare benefits including:
- Managing health and well-being programs
- Maximizing the value of their health plan benefits
- Selecting the best health plan to meet their health needs
- Choosing a quality care provider and appointment scheduling
- Premium provider education and steerage
- Pre-authorization and pre-determination requests and status
- Benefit interpretation
- Self-service tools and resources
- Healthcare literacy (correspondence and literature interpretation) + Work directly with site leadership to remove process barriers+ Navigate multiple online resource materials and follow defined process for issue handling+ Maximize use of community services, support programs, and resources available to member
- *Required Qualifications:**
- High School Diploma / GED OR equivalent work experience
- Must be 18 years of age OR older
- 1+ years of experience with helping, resolving, OR advocating on behalf of members or customers
- Current Tier I UNET Advocate for Me experience
- Current E and I Ops Consumer Services Experience
- Experience with using a computer and Microsoft Office including Microsoft Word (create correspondence and work within templates), Microsoft Excel (ability to sort, filter, and create simple spreadsheets), and Microsoft Outlook (email and calendar management)
- Ability to work any of our 8-hour shift schedules during our normal business hours of 1:30 pm - 10:00 pm CST from Monday - Friday including the flexibility to work occasional overtime based on business need
- *Preferred Qualifications:**
- Sales OR account management experience
- Healthcare / Insurance environment (familiarity with medical terminology, health plan documents, OR benefit plan design)
- Social work, behavioral health, disease prevention, health promotion, and behavior change (working with vulnerable populations)
- *Soft Skills:**
- Written and oral communication skills adaptable to live phone conversations as well as e-mail OR chat exchanges that drive a trusted relationship based on ownership reducing customer effort
- Ability to quickly build rapport and respond to members in a compassionate manner by identifying and exceeding member expectations (responding in respectful, timely manner and delivering on commitments)
- Ability to listen skillfully, collect relevant information, determine immediate requests, and identify the current and future needs of the members
- Proficient problem-solving approach to quickly assess current state and formulate recommendations
- Flexibility to customize approach to meet all types of member communication styles and personalities
- Ability to overcome objections and persuade members to take action / change behavior
- Proficient in translating healthcare-related jargon and complex processes into simple, step-by-step instructions members can understand and act upon
- Conflict management skills including: + Professionally and adeptly resolving issues while under stress+ Diffuse conflict and member distress+ Personal resilience+ Ability to utilize multiple systems / platforms while on a call with a member - strong computer skills and technical aptitude+ Attention to detail+ Ability to view change and transition in a positive way, and easily adapt to all updated requirements of the role+ Contribute to achieving the company's mission+ Show commitment to team success over personal success. Work collaboratively with others to achieve goals+ Model arenaflex's Principles of Integrity and Compliance, and adhere to our business principles+ Maintain the confidentiality of sensitive information
- *Compensation and Benefits:**
- The hourly range for this role is $19.86 to $38.85 per hour based on full-time employment. Pay is based on several factors including but not limited to local labor markets, education, work experience, certifications, etc. arenaflex complies with all minimum wage laws as applicable.
- In addition to your salary, arenaflex offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401k contribution (all benefits are subject to eligibility requirements).
- *Work Environment and Culture:**
- As a remote employee, you'll have the flexibility to work from anywhere within the U.S. while taking on some tough challenges.
- arenaflex is an Equal Employment Opportunity employer under applicable law and qualified applicants will receive consideration for employment without regard to race, national origin, religion, age, color, sex, sexual orientation, gender identity, disability, or protected veteran status, or any other characteristic protected by local, state, or federal laws, rules, or regulations.
- arenaflex is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.
- *How to Apply:**
If you're passionate about delivering exceptional customer service, have a strong understanding of healthcare, and are eager to make a difference, we want to hear from you. Apply now to join our team as an Experienced Premier Customer Service Advocate at arenaflex Hub – National Remote in Richardson, TX.
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