Senior Complex Customer Care Representative – National Remote

Are you a customer service professional with a passion for delivering exceptional experiences and making a meaningful impact in the lives of others? Do you thrive in a fast-paced, dynamic environment where no two days are ever the same? If so, we invite you to join our team at arenaflex as a Senior Complex Customer Care Representative – National Remote.

About arenaflex

arenaflex is a global organization that delivers care, aided by technology to help millions of people live healthier lives. Our mission is to make healthcare work better for everyone, and we believe that everyone deserves the opportunity to live their healthiest life. We're committed to mitigating our impact on the environment and enabling and delivering equitable care that addresses health disparities and improves health outcomes.

The Role

As a Senior Complex Customer Care Representative, you will play a critical role in delivering a best-in-class experience to our members, providing premium-level service, and removing burdens to ensure end-to-end resolution. You will build and maintain strong relationships with our members, guiding them in navigating and advocating for their benefits, claims, and access to care. This includes understanding and educating consumers on the lifecycle of a claim and prior authorization, thorough explanation of the mechanics of the benefit plan and access to provider networks, and connecting the consumer to resources for social determinants of health (SDoH) issues such as transportation, access to food, housing, and financial concerns.

Key Responsibilities

* Build and maintain strong relationships with members to provide premium-level service and remove burdens

• Answer up to 30 to 60 incoming calls, emails, and chats per day from members of our health, dental, vision, and pharmacy plans
• Contact care providers (doctor's offices) on behalf of the customer to assist with appointment scheduling or connections with internal specialists for assistance
• Demonstrate expertise in claims processing and interpretation, resolving any claim-related issues or discrepancies in a timely and efficient manner
• Identify areas of assistance and offer resolution for benefits, eligibility, claims, financial spending accounts, correspondence, pharmacy, behavioral health, and self-service options
• Educate members about the fundamentals and benefits of managing their health and well-being
• Assist in navigating arenaflex websites or applications utilizing remote desktop system capabilities
• Construct communication via secure messaging, email, 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
• 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.
• Meet performance goals established for the position in the following areas: effectiveness, efficiency, call quality, member satisfaction, first call resolution, and adherence

Additional Responsibilities

* 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
• 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
• Maximize use of community services, support programs, and resources available to members

Requirements

* High School Diploma/GED or equivalent work experience

• Must be 18 years of age or older
• 2+ years of high-demand contact center and/or customer service experience in a professional environment
• 1+ years of experience within the Healthcare Field, Advocacy Service, Customer Service, and/or Call Center Services, Sales, and Hospitality
• De-escalation experience, including the ability to ensure consumers feel heard and cared for in every interaction
• Familiarity with computer and Windows PC applications, which includes the ability to learn new and complex computer applications and apply their use while on the phone
• Proficiency with Microsoft Office, including Microsoft Excel, Microsoft Word, Microsoft Outlook, and Microsoft PowerPoint
• Ability to work Monday-Friday, in any of our 8-hour shift schedules during our normal business hours of 8:00 am-11:00 pm EST, including the flexibility to work occasional overtime and Saturdays, based on the business need

Preferred Qualifications

* Experience with medical or health terminology

• Sales experience, including a demonstrated ability to influence consumer behavior toward highest value outcomes
• Multi-lingual proficiency (e.g., English and Spanish)

Soft Skills

* Resilience and resourcefulness that deliver a best-in-class experience to solve complex healthcare problems for our consumers

• Utilize assertive soft skills to proactively identify and address members' needs, ensuring a personalized and comprehensive approach
• Ability to understand and effectively explain complex benefit plans
• Ability to overcome objections and persuade members to take action/change behavior
• Ability to use multiple systems while assisting consumers
• Flexibility to customize approach to meet all types of member communication styles and personalities
• Quality-focused
• Customer service, interpersonal, communication, and organizational skills
• Interpersonal, written, and verbal communication skills
• Problem-solving and critical thinking skills to resolve complex healthcare issues
• Attention to detail
• Conflict management skills, including:

+ Ability to resolve issues under stress + Diffuse conflict and member distress

Telecommuting Requirements

* Ability to keep all company-sensitive documents secure (if applicable)

• Required to have a dedicated work area established that is separated from other living areas and provides information privacy
• Must live in a location that can receive a UnitedHealth Group-approved high-speed internet connection or leverage an existing high-speed internet service

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.
• UnitedHealth Group complies with all minimum wage laws as applicable
• In addition to your salary, UnitedHealth Group offers benefits such as a comprehensive benefits package, incentive and recognition programs, equity stock purchase, and 401(k) contribution (all benefits are subject to eligibility requirements)

How to Apply

If you're a motivated and results-driven individual who is passionate about delivering exceptional customer experiences, we encourage you to apply for this exciting opportunity. Please submit your application, including your resume and a cover letter, through our website. We look forward to reviewing your application and discussing this opportunity further with you.

Equal Employment Opportunity

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.

Drug-Free Workplace

arenaflex is a drug-free workplace. Candidates are required to pass a drug test before beginning employment.

Contact Us

If you have any questions or would like to learn more about this opportunity, please don't hesitate to contact us. We look forward to hearing from you! Apply for this job