Job Description
Join arenaflex, a leading healthcare company, and make a difference in the lives of our customers! As a highly skilled and customer-focused Coordinator, Complaint & Appeals, you'll have the opportunity to work in a dynamic team that's passionate about delivering exceptional customer experiences and driving positive change in healthcare. At arenaflex, we believe in bringing our heart to every moment of our customers' health. Our purpose guides our commitment to deliver enhanced human-centric healthcare for a rapidly changing world. We're looking for individuals who share our passion and want to make a positive impact. **About arenaflex** arenaflex is a healthcare company that's dedicated to improving the lives of our customers. We're a team of passionate and dedicated professionals who are committed to delivering exceptional customer experiences and driving positive change in healthcare. Our company culture is built on the values of compassion, integrity, and innovation, and we're always looking for talented individuals who share our vision. **Position Summary** As a Coordinator, Complaint & Appeals, you'll be responsible for managing complaint and appeal scenarios for all products, ensuring timely and customer-focused responses. You'll identify trends and emerging issues, reporting and recommending solutions to drive continuous improvement. This is a hybrid role that offers the flexibility to work from our remote office and home, with a competitive salary and comprehensive benefits package. **Key Responsibilities:** * Review and process appeals filed by participating providers * Assist with adherence to regulatory requirements, conduct internal audits, and address compliance issues * Draft and send appeal decision letters * Identify trends and emerging issues, reporting and recommending solutions to drive continuous improvement * Collaborate with cross-functional teams to resolve complex issues and improve processes * Develop and maintain knowledge of regulatory requirements, company policies, and procedures **Requirements:** * 1 year of experience in HMO and Traditional claim platforms, products, and benefits, patient management, product, compliance and regulatory analysis, special investigations, provider relations, customer service, or audit experience * High School or Equivalent education * Strong analytical and problem-solving skills * Excellent communication and interpersonal skills * Ability to work in a fast-paced environment and prioritize multiple tasks and deadlines **Preferred Qualifications:** * Medicare experience * Claims experience * Experience in reading or researching benefit language in Summary Plan Description (SPDs) or Certificate of Coverage (COCs) * Experience in research and analysis of claim processing * Knowledge of regulatory requirements and company policies and procedures **What We Offer:** * Competitive salary: $17.00 - $28.46 per hour * Comprehensive benefits package, including 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 * Opportunities for education assistance, free development courses, and arenaflex store discounts * Collaborative and dynamic work environment with a team of passionate and dedicated professionals * Recognition and rewards for outstanding performance and contributions to the company **Career Growth Opportunities and Learning Benefits:** * arenaflex is committed to the growth and development of our employees. We offer a range of training and development programs, including on-the-job training, mentorship, and education assistance. * Our company culture is built on the values of compassion, integrity, and innovation, and we're always looking for talented individuals who share our vision. * arenaflex is a dynamic and rapidly changing company, and we're always looking for new and innovative ways to improve our products and services. **Work Environment and Company Culture:** * arenaflex is a hybrid company that offers the flexibility to work from our remote office and home. * Our company culture is built on the values of compassion, integrity, and innovation, and we're always looking for talented individuals who share our vision. * We're a team of passionate and dedicated professionals who are committed to delivering exceptional customer experiences and driving positive change in healthcare. **Compensation, Perks, and Benefits:** * Competitive salary: $17.00 - $28.46 per hour * Comprehensive benefits package, including 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 * Opportunities for education assistance, free development courses, and arenaflex store discounts **Conclusion:** If you're passionate about delivering exceptional customer experiences and driving positive change in healthcare, we want to hear from you! arenaflex is a dynamic and rapidly changing company that's committed to the growth and development of our employees. We offer a range of training and development programs, including on-the-job training, mentorship, and education assistance. Our company culture is built on the values of compassion, integrity, and innovation, and we're always looking for talented individuals who share our vision. Apply now and join our team! Apply for this job