At arenaflex, we're dedicated to delivering exceptional customer experiences and providing innovative solutions to the ever-evolving healthcare landscape. As a Claims Customer Service Advocate III, you'll play a vital role in ensuring our customers receive the highest level of service and support, while also driving business growth and excellence.
**About arenaflex**
arenaflex is a leading health insurance company with a rich history spanning over seven decades. With a strong presence in South Carolina and a national footprint, we're committed to delivering outstanding service to our customers. Our A.M. Best rating of A+ (Superior) is a testament to our financial stability and commitment to excellence. As a member of the arenaflex family, you'll be part of a diverse and inclusive workplace that values employee growth, development, and contributions.
**Job Summary**
We're seeking an experienced Claims Customer Service Advocate III to join our team in Columbia, SC. As a key member of our customer service team, you'll be responsible for providing prompt, accurate, and courteous responses to complex customer inquiries. You'll also review and adjudicate claims and appeals, ensuring compliance with organizational policies and procedures. If you're a customer service expert with a passion for resolving complex issues and delivering exceptional experiences, we encourage you to apply.
**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 determines 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.
**Essential Qualifications**
* High School Diploma or equivalent.
* 3 years of customer service experience, including 1 year of claims or appeals processing experience.
* Bachelor's Degree in lieu of work experience.
* Knowledge of Microsoft Office.
* Strong verbal and written communication skills.
* Good spelling, punctuation, and grammar skills.
* Basic business math abilities.
* Ability to handle confidential or sensitive information with discretion.
**Preferred Qualifications**
* Experience in the healthcare industry or insurance claims processing.
* Knowledge of claims processing software and systems.
* Certification in claims processing or customer service.
* Experience in process improvement and quality assurance.
**Skills and Competencies**
* Excellent customer service skills with a focus on resolving complex issues.
* Strong analytical and problem-solving skills.
* Ability to work in a fast-paced environment with multiple priorities.
* Excellent communication and interpersonal skills.
* Ability to maintain confidentiality and handle sensitive information.
* Strong attention to detail and accuracy.
* Ability to work independently and as part of a team.
**Career Growth Opportunities and Learning Benefits**
At arenaflex, we're committed to employee growth and development. As a Claims Customer Service Advocate III, you'll have opportunities to:
* Develop your skills and expertise in claims processing and customer service.
* Participate in training programs and workshops to enhance your knowledge and skills.
* Collaborate with cross-functional teams to drive business growth and excellence.
* Contribute to process improvements and quality assurance initiatives.
* Pursue career advancement opportunities within the company.
**Work Environment and Company Culture**
arenaflex is a dynamic and inclusive workplace that values diversity, equity, and inclusion. Our office is located in Columbia, SC, and we offer a range of benefits and perks, including:
* Subsidized health plans, dental, and vision coverage.
* 401(k) retirement savings plan with company match.
* Life insurance.
* Paid Time Off (PTO).
* On-site cafeterias and fitness centers in major locations.
* Education Assistance.
* Service Recognition.
* National discounts to movies, theaters, zoos, theme parks, and more.
**Compensation, Perks, and Benefits**
arenaflex offers a competitive compensation package, including:
* Salary: $ [insert salary range].
* Bonus structure: [insert bonus structure].
* Benefits: [insert benefits].
* Perks: [insert perks].
**How to Apply**
If you're a customer service expert with a passion for resolving complex issues and delivering exceptional experiences, we encourage you to apply. Please submit your resume and cover letter to our online application system. We're an equal opportunity employer and welcome applications from diverse candidates.
**Equal Employment Opportunity Statement**
arenaflex is an equal opportunity employer and maintains 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
**Veterans Welcome!**
arenaflex is a strong supporter of our veterans, and many service men and women have joined our ranks. We've found the dedication, work ethic, and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services, and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort, and in our hometown of Columbia, S.C., at Ft. Jackson. If you're a full-time employee in the National Guard or Reserves, we'll even cover the difference in your pay if you're called to active duty.
**Join Us!**
If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now!