Healthcare Customer Service Representative – Remote Policy Management, Benefits & Claims Support (New Mexico)

About arenaflex – Transforming Healthcare Support Nationwide

arenaflex is a leading provider of technology‑enabled back‑office solutions for health plans across the United States. With a mission to simplify the complex world of health insurance, arenaflex partners with more than 70 health plans, delivering end‑to‑end claims processing, member engagement, and provider services. Our innovative, cloud‑based platform—arenaflex’s proprietary workflow engine—automates claim adjudication, enhances data traceability, and drives operational efficiency for our clients. Headquartered in Tampa, Florida, arenaflex operates a network of regional hubs and a global delivery center, all united by a shared commitment to improving member experiences and supporting the healthcare ecosystem.

Why Join arenaflex?

At arenaflex, you’ll become part of a purpose‑driven team that values empathy, continuous learning, and collaboration. We empower our remote workforce with the tools, training, and culture needed to thrive while making a tangible impact on the lives of millions of members. Whether you’re a seasoned customer‑service professional or looking to deepen your expertise in health‑insurance operations, arenaflex offers a clear pathway for growth, mentorship, and recognition.

Position Overview – Healthcare Customer Service Representative II (Remote – New Mexico)

As a Healthcare Customer Service Representative II at arenaflex, you will be the trusted voice that guides members through policy management, benefits inquiries, and claims processes. Working from the comfort of your home, you will handle inbound calls, resolve complex issues, and ensure that every interaction reflects arenaflex’s commitment to excellence and compassion.

Core Responsibilities

• Policy Management
  • Process member payments, address billing questions, and resolve discrepancies with accuracy and speed.
  • Update member records—including addresses, phone numbers, beneficiaries, and employment details—ensuring data integrity across all systems.
  • Manage policy termination requests, execute reinstatements, and coordinate the issuance of ID cards, guaranteeing timely delivery and member satisfaction.
• Benefits Administration
  • Provide clear, up‑to‑date information on coverage plans, eligibility, benefits, limitations, and exclusions.
  • Assist members with prior‑authorization and referral processes, guiding them through required documentation and timelines.
  • Research and verify contact information for healthcare providers, delivering accurate details to members in need.
• Claims Support
  • Deliver precise claims‑status updates, explaining each stage of the adjudication process.
  • Answer inquiries about claim denials, offer guidance on appeal procedures, and facilitate reconsideration requests by gathering necessary documentation.
• General Member Inquiries
  • Troubleshoot website navigation issues, helping members access their accounts, view statements, and locate resources.
  • Respond to broad questions about health‑insurance plans, ensuring members receive comprehensive, accurate information.
• Additional Responsibilities
  • Uphold strict confidentiality standards, safeguarding sensitive member data at all times.
  • Escalate complex or high‑risk issues to supervisors, ensuring swift resolution and compliance with regulatory requirements.
  • Engage in continuous learning—stay current on evolving health‑insurance regulations, policy updates, and industry best practices.
  • Collaborate with teammates to achieve shared performance goals and foster a supportive, positive work environment.

Essential Qualifications

• High School Diploma or GED (required).
• Minimum of 2 years experience in one or more of the following areas:
  • Claims examination or adjudication.
  • Health‑insurance operations.
  • Customer service or call‑center environments.
  • Medical office or other healthcare‑related settings.
• Demonstrated proficiency with medical terminology, ICD‑9 and ICD‑10 coding, and eligibility verification.
• Strong verbal communication skills, with the ability to convey complex information in a clear, empathetic manner.
• Proven track record of meeting daily schedules, performance metrics, and quality standards.
• Ability to multitask, maintain meticulous attention to detail, and manage time effectively.
• Self‑motivated, organized, and capable of thriving both independently and as part of a collaborative team.
• Successful completion of a criminal background check.

Preferred Skills & Competencies

• Advanced knowledge of health‑insurance policy workflows, benefits verification, and claims processing.
• Comfort with computer operations—data entry, screen navigation, and keyboard proficiency.
• Experience using CRM or claims‑management platforms (experience with arenaflex’s proprietary system is a plus).
• Exceptional problem‑solving abilities, with a focus on delivering solutions that enhance member satisfaction.
• Demonstrated commitment to continuous improvement and professional development.

Work‑From‑Home Requirements

• High‑speed internet connection (minimum 25 Mbps download / 5 Mbps upload) with a verified speed test.
• Hard‑wired connection to your modem for optimal stability.
• Dedicated, quiet workspace free from distractions.

Compensation, Benefits & Perks

arenaflex offers a competitive hourly wage ranging from $17.00 to $19.00 based on experience and performance. In addition to a robust base pay, you’ll enjoy a comprehensive benefits package that includes:

• Paid training period to ensure you’re fully equipped for success.
• Medical, dental, vision, life insurance, and Health Savings Account (HSA) eligibility after 30 days of service.
• Seven paid holidays with no waiting period.
• Six paid time‑off (PTO) days and eligibility for a 401(k) retirement plan after 90 days.
• All necessary equipment (computer, headset, and accessories) provided by arenaflex.
• Opportunities for career advancement, internal mobility, and professional certifications.
• Regular virtual team‑building events, wellness resources, and an employee assistance program.

Career Growth & Development at arenaflex

arenaflex invests heavily in the growth of its people. As a member of our remote customer‑service team, you will have access to:

• Structured onboarding and ongoing mentorship from seasoned industry experts.
• Online learning portals covering advanced claims adjudication, regulatory compliance, and soft‑skill development.
• Clear career pathways—move from Representative II to Senior Representative, Team Lead, or specialized roles in Quality Assurance, Training, and Operations Management.
• Cross‑functional exposure to technology, analytics, and product development teams, broadening your skill set beyond traditional call‑center duties.

Our Culture – The arenaflex Way

At arenaflex, we believe that a supportive, inclusive culture fuels exceptional performance. Our remote workforce is united by shared values:

• Empathy: We put members’ needs at the heart of every interaction.
• Integrity: Confidentiality and ethical conduct guide all decisions.
• Innovation: We continuously seek smarter ways to simplify health‑insurance processes.
• Collaboration: Team members across the nation work together, celebrating successes and learning from challenges.
• Growth Mindset: We encourage curiosity, ongoing education, and the pursuit of new opportunities.

Our virtual community includes regular town‑hall meetings, recognition programs, and a vibrant internal network that connects you with peers, mentors, and leadership.

Application Process & Next Steps

If you are passionate about delivering outstanding service, thrive in a fast‑paced remote environment, and want to contribute to a company that is reshaping the healthcare support landscape, we want to hear from you. To apply, click the link below, submit your resume, and complete a brief questionnaire. Our recruiting team will review your application, schedule a virtual interview, and guide you through the next steps.

Ready to make a difference? Join arenaflex today and become a vital part of a team that puts members first.

Apply Now – Healthcare Customer Service Representative (Remote – New Mexico)