Job Description
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Welcome to arenaflex – A Legacy of Community‑Focused Health Solutions
For more than seven decades, arenaflex has been a cornerstone of health insurance excellence in the Carolinas and a trusted partner for government contracts nationwide. Our expansive portfolio includes sophisticated data‑processing centers, a diverse family of subsidiary businesses, and a reputation for delivering outstanding service to members, providers, and communities alike. As a forward‑thinking organization grounded in deep local roots, we blend reliability with innovation, creating a workplace where talent thrives and careers grow.
Why Join arenaflex?
Choosing arenaflex means becoming part of a dynamic team that values both stability and evolution. You’ll work alongside industry experts, leverage cutting‑edge technology, and contribute to a mission that directly impacts the health and well‑being of millions. Our inclusive culture celebrates diversity, encourages continuous learning, and rewards dedication with competitive benefits and clear pathways for advancement.
Position Overview – Claims Customer Service Advocate II
As a Claims Customer Service Advocate II at arenaflex, you will serve as the frontline champion for our members, handling complex inquiries, processing claims, and adjudicating non‑medical appeals. This role demands a blend of analytical rigor, empathetic communication, and a commitment to uphold the highest standards of accuracy and compliance.
Key Responsibilities
- Member Interaction: Respond promptly and courteously to telephone, email, web portal, and walk‑in inquiries, ensuring each member feels heard and valued.
- Complex Issue Resolution: Manage non‑routine requests that require deviation from standard scripts or screens, conducting in‑depth research to deliver accurate solutions.
- Claims Examination: Review, verify, and enter claims into the arenaflex claims system, confirming correct procedural and diagnosis coding.
- Adjudication & Appeals: Assess non‑medical appeals against contractual regulations and internal policies, determining appropriate actions—payment, denial, or return.
- Quality Assurance: Identify incorrectly processed claims, initiate adjustments or re‑processing in line with departmental guidelines, and maintain production standards.
- Escalation Management: Recognize complex complaints that exceed desk‑level authority, escalating them to leads or managers for resolution.
- Fraud Detection: Spot potential fraud or abuse indicators, documenting and reporting them to the appropriate compliance team.
- Collaboration: Work closely with cross‑functional teams—including underwriting, provider relations, and IT—to streamline processes and improve member experience.
- Documentation: Maintain meticulous records of all interactions, decisions, and actions taken, ensuring audit‑ready compliance.
Qualifications – What You Bring to the Table
Essential Experience & Education
- Minimum 2 years of customer service experience, with at least 1 year dedicated to claims or appeals processing, or a Bachelor’s Degree in a related field as an alternative.
- High school diploma or equivalent is required; post‑secondary education is a strong advantage.
Core Skills & Abilities
- Excellent verbal and written communication skills; ability to convey complex information clearly and compassionately.
- Strong customer‑service orientation with a focus on empathy and problem‑solving.
- Proficiency in business mathematics, including basic calculations related to claim amounts and adjustments.
- Attention to detail in spelling, punctuation, and grammar—critical for accurate documentation.
- Discretion in handling confidential and sensitive member information, adhering to HIPAA and privacy standards.
- Competence with Microsoft Office Suite (Word, Excel, Outlook) and willingness to learn specialized claim‑management software.
Preferred Qualifications
- Previous experience in a health‑insurance environment, especially with government contracts.
- Familiarity with ICD‑10 coding, CPT procedures, and other medical billing standards.
- Certifications such as Certified Professional Claims Adjuster (CPCA) or similar.
- Experience working in a fast‑paced office with occasional overtime requirements.
Skills & Competencies for Success
- Analytical Thinking: Ability to dissect complex claim scenarios and determine appropriate outcomes.
- Conflict Resolution: Skilled at de‑escalating frustrated members and turning challenging interactions into positive experiences.
- Time Management: Prioritize multiple tasks while meeting daily production and quality targets.
- Adaptability: Comfortable navigating evolving policies, technology upgrades, and regulatory changes.
- Team Collaboration: Work effectively within a multidisciplinary team, sharing insights and supporting peers.
Career Growth & Learning Opportunities at arenaflex
arenaflex is committed to your professional development. As a Claims Customer Service Advocate II, you will have access to:
- Structured onboarding and mentorship programs with senior claims adjusters.
- Continuing education courses—both internal and external—to deepen your knowledge of health‑care regulations, coding, and customer experience best practices.
- Clear career pathways leading to senior advocacy roles, claims supervision, or specialized compliance positions.
- Opportunities to cross‑train in related departments such as provider relations, underwriting, or data analytics.
- Tuition reimbursement and education assistance for relevant certifications.
Work Environment & Culture
Based at our modern Columbia, SC campus (4101 Percival Road), you’ll enjoy a typical office setting with ergonomic workstations, collaborative spaces, and a supportive atmosphere. Our culture is built on:
- Inclusivity: A workplace where every voice is respected, and diverse perspectives drive innovation.
- Community Engagement: Volunteer initiatives and partnerships that strengthen the local community we serve.
- Recognition: Regular awards and service‑recognition programs that celebrate individual and team achievements.
- Well‑Being: On‑site cafeteria options, fitness centers at major locations, and wellness programs encouraging a healthy work‑life balance.
Compensation, Perks & Benefits
We offer a comprehensive package designed to support your financial security, health, and personal growth:
- Competitive Salary: Market‑aligned base pay commensurate with experience and expertise.
- 401(k) Plan: Company match to help you build a robust retirement nest‑egg.
- Health & Vision Coverage: Subsidized medical plans plus free vision benefits.
- Life Insurance: Coverage to protect you and your loved ones.
- Paid Time Off (PTO): Generous vacation, sick leave, and holidays.
- Education Assistance: Financial support for relevant coursework and certifications.
- Employee Discounts: Access to national discounts for movies, theme parks, zoos, and more.
- Flexible Work Options: While the role is primarily office‑based, occasional cross‑building travel may be required, and overtime is offered when needed.
Commitment to Diversity, Equity & Inclusion
arenaflex actively cultivates a diverse workforce where all employees—regardless of race, gender, age, veteran status, disability, sexual orientation, gender identity, or any protected characteristic—can thrive. We value the unique contributions of each individual and provide reasonable accommodations for disabilities, pregnancy‑related conditions, and sincerely held religious beliefs.
Application Process & Next Steps
Ready to make a meaningful impact with arenaflex? After you submit your application, our recruiting team will review your qualifications. Qualified candidates will be contacted for a brief phone interview or email exchange to confirm resume details, salary expectations, and availability. We strive to keep the process transparent, timely, and respectful of your schedule.
Equal Employment Opportunity Statement
arenaflex and its subsidiaries are proud to be an equal‑opportunity employer. We adhere to all federal, state, and local nondiscrimination laws, maintain affirmative‑action programs for veterans and individuals with disabilities, and participate in E‑Verify. All employment decisions are based on merit, qualifications, and business needs.
Accommodations & Contact Information
If you require a reasonable accommodation during the recruitment process, please email [email protected] or call 800‑288‑2227, ext. 47480. We will assess each request promptly and fairly.
Join arenaflex Today!
Take the next step toward a rewarding career where your expertise matters, your growth is supported, and your contributions improve the health and happiness of our members. Apply now and become part of the arenaflex family—a place where tradition meets innovation, and every employee is empowered to succeed.
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