Experienced Customer Service Representative – Healthcare Industry

At arenaflex, we're committed to empowering New Yorkers by uniting communities through care. As a Customer Service Representative, you'll play a vital role in delivering exceptional service to our members and providers, ensuring they receive the highest quality healthcare services. If you have a passion for helping others and a collaborative spirit, we invite you to join our team.

About arenaflex

arenaflex provides comprehensive healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens, and Staten Island through a range of products, including New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, and more. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, our network includes over 27,000 primary care providers, specialists, and participating clinics. For over 30 years, arenaflex has been dedicated to building strong relationships with our members and providers to enable New Yorkers to live their healthiest lives.

Position Overview

As a Customer Service Representative, you'll be responsible for providing comprehensive, high-quality service to all customers. Your primary responsibilities will include:

• Answering customer calls and proactively working to resolve member and provider questions and concerns
• Researching and responding accurately to all customer inquiries related to eligibility, benefits/services, claims, and authorizations
• Classifying and recording all customer encounters clearly and concisely
• Identifying and escalating complex issues and providing follow-up/closure
• Intaking customer complaints and capturing all pertinent information
• Assisting members with Primary Care Provider (PCP) selection, locating providers and vendors within our network, and verifying and updating member demographic information
• Processing requests for member materials, handling enrollment inquiries, generating sales leads, and handling disenrollment requests
• Performing outreach related to New Member Orientation and PCP term/reassign projects
• Processing premium payments and performing other duties as assigned by the Director of Customer Service

Key Responsibilities

* Strive for first call resolution, working to resolve member and provider issues as the point of contact

• Utilize dual monitors and leverage computer-based resources to find answers to customer questions
• Research and respond accurately to all customer inquiries related to eligibility, benefits/services, claims, and authorizations
• Classify and record all customer encounters clearly and concisely
• Identify and escalate complex issues and provide follow-up/closure
• Identify and intake customer complaints capturing all pertinent information
• Assist members with PCP selection, as well as, locating providers and vendors within plan's network
• Verify and update member demographic information
• Process requests for member materials, such as ID cards, member guide, provider directory, etc.
• Handle enrollment inquiries and generate sales leads
• Handle disenrollment requests and pro-actively conduct retention efforts
• Perform outreach related to New Member Orientation and PCP term/reassign projects
• Process premium payments
• All other duties and special projects as assigned by the Director of Customer Service

Work Schedule

* Ability to work between 8:00 AM and 6:00 PM Monday - Friday, and 9:00 AM-5:00 PM Saturday

• Training class (Paid): 9:00 AM-5:00 PM Monday-Friday

Minimum Qualifications

* High School graduation or evidence of having satisfactory passed a High School Equivalency Program

• Minimum 1 year experience in a call center environment
• A satisfactory equivalent combination of education, training, and experience
• Managed care experience preferred
• Proven experience in providing excellent service to customers in various healthcare-related areas (i.e., insurance, doctor's office, medical clinics)
• Poise under pressure when dealing with difficult situations and potentially upset customers
• Ability to work in a fast-paced environment while keeping a high attention to detail

Professional Competencies

* Integrity and Trust

• Customer Focus
• Functional/Technical Skills
• Written/Oral Communication

Why Join arenaflex?

* Opportunity to work for a leading healthcare organization that's committed to empowering New Yorkers

• Comprehensive training program to ensure your success in the role
• Collaborative and supportive work environment
• Competitive compensation and benefits package
• Opportunities for career growth and professional development
• Flexible work schedule, including remote work options

How to Apply

If you're passionate about delivering exceptional customer service and making a difference in the lives of New Yorkers, we encourage you to apply for this exciting opportunity. Please submit your application through our website, including your resume and a cover letter outlining your experience and qualifications. Apply Now We look forward to welcoming you to our team! Apply for this job