Rewritten Job Title:

Join arenaflex as an Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert

At arenaflex, we're committed to delivering exceptional customer experiences and resolving complex claims with precision and care. As an Experienced Claims Customer Service Advocate III, you'll play a vital role in our mission to provide unparalleled service to our customers. If you're passionate about delivering outstanding customer experiences, resolving complex claims, and working in a dynamic team environment, we invite you to join our team!

About arenaflex

arenaflex is a leading health insurance company with a rich history of serving the South Carolina community for over seven decades. With a strong commitment to excellence, innovation, and customer satisfaction, we've earned an A+ (Superior) rating from A.M. Best, making us the only health insurance company in South Carolina with this prestigious rating. Our diverse family of subsidiary companies allows us to build on a variety of business strengths, and we're proud to be one of the nation's leading administrators of government contracts.

Why Join arenaflex?

• Be part of a dynamic team that values customer satisfaction and excellence
• Work in a fast-paced, innovative environment that encourages growth and development
• Enjoy a comprehensive benefits package, including 401(k) retirement savings plan, subsidized health plans, and free vision coverage
• Take advantage of tuition assistance, continuing education funds, and service recognition programs
• Be part of a company that values diversity, equity, and inclusion, and is committed to creating a workplace that's welcoming and inclusive for all employees

Job Summary

We're seeking an Experienced Claims Customer Service Advocate III to join our team in a full-time, onsite role at our Percival Road or Greenville location, with potential work-from-home opportunities. As a Claims Customer Service Advocate III, you'll provide prompt, accurate, and courteous responses to complex customer inquiries, resolve claims and appeals, and ensure that contract standards and objectives for timeliness, productivity, and quality are met.

Key Responsibilities:

• Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed
• Researches to identify underlying causes and determine ways to prevent and correct such causes
• Identifies and reports potential fraud and abuse situations
• Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity, and quality are met
• Handles situations that require adaptation of response or extensive research
• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes
• Ensures claims are processing according to established quality and production standards
• Provides feedback to management regarding customer issues
• Maintains accurate records concerning issues
• Follows through on complaints until resolved or reports to management as needed
• Maintains knowledge of procedures and policies
• Assists with process improvements by recommending improvements in procedures and policies
• Assists in training claims customer service representatives

Qualifications:

To qualify for this position, you'll need:

• A High School Diploma or equivalent
• 3 years of customer service experience, including 1 year of claims or appeals processing experience, or a Bachelor's Degree in lieu of work experience
• Good verbal and written communication skills
• Strong customer service skills
• Good spelling, punctuation, and grammar skills
• BASIC business math abilities
• Ability to handle confidential or sensitive information with discretion
• Microsoft Office skills

Preferred Qualifications:

We prefer candidates with:

• A Bachelor's degree in Business Administration, Healthcare Administration, or other job-related field
• ADGS/Engage One system knowledge

What We Can Do for You:

At arenaflex, we're committed to providing a comprehensive benefits package that supports your physical, emotional, and financial well-being. Our benefits include:

• 401(k) retirement savings plan with company match
• Subsidized health plans and free vision coverage
• Life insurance
• Paid annual leave – the longer you work here, the more you earn
• Nine paid holidays
• On-site cafeterias and fitness centers in major locations
• Wellness programs and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Incentive Plan
• Merit Plan
• Continuing education funds for additional certifications and certification renewal

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

Salary Range Information:

The salary range for this position is $14.92 - $27.50 per hour, with a midpoint of $21.21 per hour.

Equal Employment Opportunity Statement:

arenaflex and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. We're committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request.

Join Our Team:

If you're ready to join a dynamic team that values customer satisfaction, excellence, and innovation, apply for this position now! We look forward to welcoming you to the arenaflex family!