Member Advocate – Healthcare Customer Service Specialist – Patient Support, Benefit Education & Care Coordination

About arenaflex – Pioneering Payment Integrity in Healthcare

arenaflex is a leading independent payment integrity firm dedicated to safeguarding the financial health of the nation’s healthcare system. By leveraging advanced technology and deep industry expertise, we help health plans, providers, and government programs identify and correct improper payments, ensuring that resources are directed toward the most important goal – delivering high‑quality care and healthier lives for every patient.

Our mission is built on five core pillars: People, Innovation, Integrity, Fun, and an Ownership Culture. At arenaflex, you’ll join a collaborative community where every voice matters, ideas are celebrated, and you are empowered to make a tangible impact on the healthcare ecosystem.

Why This Role Matters

As a Healthcare Customer Service Member Advocate at arenaflex, you will be the trusted liaison between health plan members and the complex network of medical professionals, pharmacies, and support services. Your expertise will guide members through benefit education, appointment scheduling, referral navigation, and cost‑management strategies, ultimately helping them achieve better health outcomes while reducing unnecessary expenses.

Key Responsibilities

• Outbound Outreach: Initiate calls to members who have identified gaps in care, offering personalized assistance and proactive solutions.
• Inbound Support: Answer incoming calls, address program‑related inquiries, and meticulously document each interaction in the case management system.
• Benefit Education: Clearly explain copays, coinsurance, deductibles, in‑network vs. out‑of‑network benefits, and formularies to empower members to make informed decisions.
• Care Coordination: Schedule follow‑up appointments, coordinate referrals, and connect members with community resources that address social determinants of health.
• Professional Relationships: Build and maintain collaborative relationships with colleagues, healthcare providers, case managers, and external contractors.
• Due Diligence Follow‑Ups: Conduct thorough research and take decisive action to resolve member concerns, escalating when necessary.
• Accurate Documentation: Log all contact attempts, outcomes, and case notes in arenaflex’s secure system, ensuring a complete audit trail.
• Escalation & Reporting: Notify management of escalated concerns, potential legal actions, government interventions, or process improvement suggestions.
• Regulatory Compliance: Stay current with campaign regulations, contract requirements, and HIPAA standards, maintaining active certification.
• Team Collaboration: Communicate effectively with cross‑functional teams to resolve complex issues and share best practices.
• Miscellaneous Duties: Perform additional tasks as assigned, always upholding a professional and courteous demeanor.

Essential Qualifications

• Minimum 4 years of experience in medical customer service, demonstrating a solid foundation in member interaction and support.
• At least 1 year of experience in medical claims processing or billing (preferred but not mandatory).
• High school diploma or equivalent; additional certifications in health administration or related fields are a plus.
• Proven ability to multitask in a fast‑paced environment while maintaining attention to detail.
• Strong verbal and written communication skills, with the ability to convey complex information in an understandable manner.
• Demonstrated proficiency with data entry, computer navigation, and case management software.
• Professional, courteous, and respectful attitude toward members, colleagues, and healthcare partners.
• Flexibility to adapt to non‑standard situations and resolve unique member challenges.
• Current HIPAA certification and commitment to maintaining confidentiality of sensitive health information.

Preferred Skills & Competencies

• Experience with Medicare, Medicaid, or commercial health plan environments.
• Familiarity with electronic health record (EHR) systems and pharmacy benefit management platforms.
• Ability to interpret and explain insurance terminology, including deductibles, out‑of‑pocket maximums, and formulary tiers.
• Strong problem‑solving mindset with a focus on delivering member‑centric solutions.
• Team‑oriented attitude with a willingness to share knowledge and mentor newer staff.
• Comfort with remote or hybrid work settings, including reliable high‑speed internet and a dedicated home office space.

Compensation & Benefits

arenaflex offers a competitive hourly rate of $21.50 per hour, reflecting the value we place on skilled, compassionate professionals. In addition to base compensation, you will have access to a comprehensive benefits package designed to support your health, financial security, and work‑life balance:

• Medical, dental, and vision insurance options with flexible spending accounts.
• Disability and life insurance coverage for added peace of mind.
• 401(k) retirement plan with employer matching contributions.
• Paid family and parental leave, plus 11 paid holidays each year.
• Generous vacation and sick time accruals to recharge and maintain wellbeing.
• Opportunities for professional development, certifications, and tuition reimbursement.
• Employee assistance programs, wellness initiatives, and virtual fitness resources.

Career Growth & Learning Opportunities

At arenaflex, your career trajectory is guided by continuous learning and advancement. Whether you aim to deepen your expertise in member advocacy, transition into claims analysis, or move toward leadership roles in operations or client services, we provide clear pathways:

• Mentorship Programs: Pairing with seasoned professionals to accelerate skill development.
• Cross‑Functional Training: Exposure to billing, compliance, analytics, and technology teams.
• Leadership Development: Access to workshops, webinars, and coaching for aspiring managers.
• Certification Support: Funding for industry‑recognized credentials such as Certified Patient Advocate (CPA) or Certified Professional Coder (CPC).

Work Environment & Culture at arenaflex

Our culture is built on collaboration, respect, and a shared commitment to improving healthcare outcomes. Key aspects of the arenaflex experience include:

• Ownership Culture: Employees are encouraged to take initiative, propose innovations, and own the results of their work.
• Inclusive Community: Diversity of thought, background, and experience is celebrated, fostering a vibrant and supportive workplace.
• Fun & Engagement: Regular virtual socials, team challenges, and recognition programs keep morale high.
• Flexibility: Hybrid and fully remote options empower you to balance personal commitments with professional responsibilities.
• Technology‑Driven: State‑of‑the‑art tools and platforms streamline workflows, allowing you to focus on member interaction rather than administrative burdens.

Compliance & Security Commitment

arenaflex operates under strict regulatory standards, including adherence to HIPAA, drug‑free workplace policies, and client‑specific contractual obligations. All team members must:

• Pass a pre‑hire criminal background check and drug screening.
• Maintain eligibility for any required client clearances.
• Sign and comply with the arenaflex Teleworker Agreement (for remote staff).
• Report any data confidentiality or integrity concerns promptly.

Equal Opportunity & Accessibility

arenaflex is committed to creating an inclusive environment where every qualified individual can thrive. We provide reasonable accommodations for candidates with disabilities throughout the recruitment process and on the job. If you require assistance, please contact our Human Resources team.

Apply Today – Join arenaflex’s Mission‑Driven Team

If you are passionate about helping members navigate the complexities of healthcare, possess a strong service orientation, and thrive in a dynamic, technology‑enabled environment, we invite you to apply. Become a vital part of arenaflex’s mission to protect payment integrity and improve patient outcomes.

Click here to submit your application and start a rewarding career with arenaflex.