Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert
**Rewritten Job Description:**
Join arenaflex, a Dynamic and Innovative Company with a Rich History
At arenaflex, we're committed to delivering exceptional customer experiences and providing innovative solutions to our customers. As a Claims Customer Service Advocate III, you'll play a critical role in resolving complex claims and ensuring that our customers receive the highest level of service. If you're passionate about delivering outstanding customer experiences and have a knack for resolving complex issues, we want to hear from you!
About the Role
We're seeking an experienced Claims Customer Service Advocate III to join our team at arenaflex. In this role, you'll be responsible for providing prompt, accurate, and courteous responses to complex customer inquiries. You'll work closely with our claims customer service representatives to resolve issues, research and respond to complex customer inquiries, 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 be successful in this role, 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.
- The ability to handle confidential or sensitive information with discretion.
- Microsoft Office skills.
Preferred Qualifications:
We're looking for candidates with:
- A Bachelor's degree in Business Administration, Healthcare Administration, or other job-related field.
- ADGS/Engage One system knowledge.
What We Offer:
At arenaflex, we're committed to providing a comprehensive benefits package that includes:
- 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:
Range Minimum: $14.92
Range Midpoint: $21.21
Range Maximum: $27.50
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. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals, and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state, and local laws and regulations.
Join Our Team:
If you're ready to join a dynamic company with secure, community roots and an innovative future, apply for a position now! We're committed to delivering exceptional customer experiences and providing innovative solutions to our customers. If you're passionate about delivering outstanding customer experiences and have a knack for resolving complex issues, we want to hear from you!