Job Description
At arenaflex, we're dedicated to delivering exceptional customer experiences that make a meaningful difference in people's lives. As a Bilingual Customer Service Representative, you'll be the face of our organization, impacting the lives of our members by providing top-notch service and support. If you're passionate about delivering world-class customer experiences, have a heart for helping others, and are fluent in both English and Spanish, we want to hear from you! About arenaflex arenaflex is a leading healthcare organization that's committed to transforming the way healthcare is delivered.
Our purpose is to bring our heart to every moment of our members' health, and we're looking for talented individuals who share our passion for making a difference. At arenaflex, we believe that our employees are the heart of our organization, and we're dedicated to creating a culture that's inclusive, supportive, and empowering. Our Heart At Work Behaviors
Our Heart At Work Behaviors are the foundation of our culture, and they guide everything we do. We want every employee to feel empowered by the role they play in transforming our culture and accelerating our ability to innovate and deliver solutions that make healthcare more personal, convenient, and affordable.
Our Heart At Work Behaviors include: * Empathy: We put ourselves in our members' shoes and understand their unique needs and perspectives. * Collaboration: We work together as a team to achieve our goals and deliver exceptional results. * Innovation: We're always looking for new and better ways to solve problems and improve our services. * Accountability: We take ownership of our actions and results, and we're committed to delivering high-quality work. * Integrity: We operate with transparency, honesty, and ethics in everything we do.
Job Summary As a Bilingual Customer Service Representative, you'll be responsible for providing exceptional service and support to our members via phone, email, and written correspondence. You'll engage with members to understand their unique needs and preferences, and you'll educate them on our plans, tools, and resources to help them navigate the healthcare system. You'll also be responsible for resolving complex issues, answering questions, and providing guidance on our services and benefits. Key Responsibilities * Answer questions and resolve issues based on phone calls, letters, and emails from members, providers, and plan sponsors.
* Triage resulting rework to appropriate staff and document and track contacts with members, providers, and plan sponsors. * Guide members through their plan of benefits, bolthires policy and procedures, and provide knowledge of resources to comply with regulatory guidelines. * Create an emotional connection with members by understanding and engaging with them to champion their best health. * Take accountability to fully understand members' needs by building trusting and caring relationships with them. * Anticipate customer needs and provide related information to answer unasked questions.
* Use customer service threshold framework to make financial decisions to resolve member issues. * Explain members' rights and responsibilities in accordance with contract. * Process claim referrals, new claim handoffs, nurse reviews, complaints, grievances, and appeals via bolthires system. * Educate providers on our self-service options and assist providers with credentialing and re-credentialing issues. * Respond to requests received from bolthires's Law Document Center regarding litigation and lawsuits.
* Handle extensive file review requests and assist in preparation of complaint trend reports. * Determine medical necessity, applicable coverage provisions, and verify member plan eligibility relating to incoming correspondence and internal referrals. * Handle incoming requests for appeals and pre-authorizations not handled by Clinical Claim Management. * Perform review of member claim history to ensure accurate tracking of benefit maximums and/or coinsurance/deductible. * Perform financial data maintenance as necessary.
* Use applicable system tools and resources to produce quality letters and spreadsheets in response to inquiries received. Essential Qualifications * Bilingual – written and oral fluency in Spanish and English. * High School or GED equivalent. * Ability to work any shift, including overnights, weekends, and holidays. Preferred Qualifications * Customer service experience in a transaction-based environment, such as a call center or retail location, demonstrating ability to be empathetic and compassionate.
* Ability to multi-task to accomplish workload efficiently. * Understanding of medical terminology. * Proficient oral and written communication skills. * Proficient with bolthires Word and Outlook. * Ability to maintain accuracy and production standards. * Negotiation skills. * Technical skills. * Problem-solving skills. * Attention to detail and accuracy. * Analytical skills. Skills and Competencies * Excellent communication and interpersonal skills. * Ability to work in a fast-paced environment and prioritize tasks effectively.
* Strong problem-solving and analytical skills. * Ability to maintain confidentiality and handle sensitive information. * Strong customer service skills and ability to resolve complex issues. * Ability to work independently and as part of a team. * Strong technical skills, including proficiency in bolthires Office and other relevant software. Career Growth Opportunities and Learning Benefits At arenaflex, we're committed to helping our employees grow and develop their careers. We offer a range of training and development programs, including: * On-the-job training and mentorship.
* Leadership development programs. * Professional certification programs. * Education assistance and tuition reimbursement. * Opportunities for advancement and career growth. Work Environment and Company Culture We're proud of our inclusive and supportive work environment, and we're committed to creating a culture that's empowering and engaging. Our office is a dynamic and fast-paced environment, and we're always looking for ways to improve and innovate. We offer a range of benefits and perks, including: * Flexible work arrangements and telecommuting options.
* Comprehensive medical, dental, and vision benefits. * 401(k) retirement savings plan and Employee Stock Purchase Plan. * Paid time off and holidays. * Employee discounts and recognition programs. * Opportunities for professional development and growth. Compensation and Benefits We offer a competitive salary range of $17.00 - $29.88, depending on experience and qualifications. In addition to your compensation, you'll enjoy a range of benefits, including: * Comprehensive medical, dental, and vision benefits.
* 401(k) retirement savings plan and Employee Stock Purchase Plan. * Paid time off and holidays. * Employee discounts and recognition programs. * Opportunities for professional development and growth. If you're passionate about delivering exceptional customer experiences and have a heart for helping others, we want to hear from you! Please apply including your resume and cover letter, to our online application system. We look forward to reviewing your application and learning more about your qualifications and experience.
Application Deadline We anticipate the application window for this opening will close on May 17, 2024. Don't miss this opportunity to and make a meaningful difference in people's lives!