```html
About arenaflex
arenaflex is a leading health benefits organization dedicated to delivering high‑quality, affordable care solutions to millions of members across the United States. With a legacy of innovation, community focus, and a data‑driven approach, arenaflex continues to redefine the way health services are accessed and experienced. Our mission is to empower members, providers, and partners through transparent, compassionate, and efficient processes that put people first. As we expand our footprint, we are looking for talented professionals who share our commitment to excellence and want to shape the future of health‑care customer service.
Why Join arenaflex?
At arenaflex, you will be part of a collaborative, inclusive, and forward‑thinking environment where every voice matters. We celebrate diversity, encourage continuous learning, and reward innovative thinking. Our employees benefit from a supportive leadership team, clear career pathways, and a culture that balances high performance with work‑life harmony. Whether you are just beginning your professional journey or are a seasoned specialist, arenaflex offers the tools, mentorship, and resources you need to thrive.
Key Responsibilities
As a Claims Customer Service Advocate II, you will be the frontline champion for our members and partners, ensuring accurate, timely, and courteous resolution of inquiries and claims.
- Respond promptly and professionally to telephone, email, web portal, and walk‑in inquiries, delivering a consistent, high‑quality member experience.
- Investigate non‑routine issues that require deviation from standard scripts, screens, or procedures, applying sound judgment and thorough research.
- Identify incorrectly processed claims, initiate appropriate adjustments, and coordinate re‑processing actions in line with departmental guidelines.
- Review and adjudicate claims and non‑medical appeals, ensuring decisions align with contractual regulations, internal policies, and best‑practice standards.
- Enter claim details into the claims management system, verifying accurate coding of procedures and diagnoses to prevent downstream errors.
- Maintain quality and production standards, meeting or exceeding established key performance indicators (KPIs) for throughput, accuracy, and member satisfaction.
- Escalate complex complaints or inquiries that fall outside standard desk procedures to team leads or managers, documenting all steps taken.
- Detect, document, and report potential fraud, abuse, or waste, collaborating with the Fraud Prevention Team to protect the organization and its members.
- Contribute to continuous‑improvement initiatives by providing feedback on process bottlenecks, suggesting enhancements, and participating in training sessions.
Essential Qualifications
- Education: High School Diploma or equivalent required; a Bachelor’s degree may be substituted for work experience.
- Experience: Minimum two years of customer‑service experience, with at least one year focused on claims or appeals processing.
- Communication: Excellent verbal and written skills, including strong spelling, punctuation, and grammar.
- Customer Service Orientation: Demonstrated ability to handle member inquiries with empathy, patience, and professionalism.
- Analytical Ability: Proficient in basic business mathematics and comfortable performing data verification and reconciliation.
- Confidentiality: Proven track record of handling sensitive information with discretion and adherence to privacy regulations (HIPAA, etc.).
Preferred Qualifications
- One year of call‑center experience, specifically within a claims or appeals environment.
- Familiarity with health‑care terminology, coding systems (ICD‑10, CPT), and insurance contract language.
- Experience with claims management software or enterprise resource planning (ERP) tools.
- Certification or training in customer‑service excellence, such as Certified Customer Service Professional (CCSP).
Core Skills & Competencies
- Problem‑Solving: Ability to diagnose issues quickly, propose solutions, and follow through to resolution.
- Attention to Detail: Meticulous verification of claim data to ensure accuracy and compliance.
- Time Management: Proven capability to prioritize tasks, meet deadlines, and manage a high‑volume workload.
- Team Collaboration: Strong interpersonal skills for cooperating with peers, supervisors, and cross‑functional teams.
- Adaptability: Comfort with changing regulations, new software platforms, and evolving business processes.
- Technical Proficiency: Comfortable navigating Windows‑based applications, Microsoft Office Suite, and web‑based portals.
Career Development & Learning Opportunities
arenaflex invests heavily in employee growth. As a Claims Customer Service Advocate II, you will have access to:
- Structured onboarding and mentorship from senior claims specialists.
- Continuous on‑the‑job training, webinars, and workshops covering advanced claims adjudication, regulatory updates, and soft‑skill development.
- Tuition assistance for relevant certifications or degree programs.
- Clear promotion pathways to senior advocate, team lead, or claims operations manager roles.
- Opportunities to participate in cross‑departmental projects, such as process automation or fraud‑prevention initiatives.
Compensation, Benefits & Perks
arenaflex offers a competitive total‑reward package designed to support your financial, health, and personal well‑being:
- Base salary commensurate with experience and market benchmarks.
- 401(k) retirement plan with generous company match.
- Comprehensive medical, dental, and vision plans with subsidized premiums.
- Life and short‑term/long‑term disability insurance.
- Paid Time Off (PTO) accruals, paid holidays, and sick leave.
- On‑site cafeteria options and access to fitness centers at major locations.
- Wellness programs, including health screenings, fitness challenges, and lifestyle discount premiums.
- Employee recognition programs that celebrate service milestones and outstanding performance.
- Employee Assistance Program (EAP) for confidential counseling and support.
- Discounts on entertainment, theme parks, museums, and other partner venues.
Work Environment & Logistics
This full‑time position is based onsite at our modern campus located at 4101 Percival Rd., Columbia, SC 29229. Regular business hours are 8:00 a.m. – 4:30 p.m., Monday through Friday. The facility features open workspaces, private focus booths, collaborative meeting rooms, and a welcoming break area. Safety protocols, ergonomic workstations, and a clean‑air environment are standard to ensure a comfortable daily experience.
Application Process
After you submit your application, our recruiting team will review your résumé to verify that you meet the essential qualifications. Qualified candidates may be invited to a brief phone screening or a virtual interview to discuss experience, salary expectations, and cultural fit. Those who advance will meet with hiring managers and potentially a panel of team members. We prioritize candidates who demonstrate both the required and preferred qualifications, as well as a passion for delivering exceptional member service.
Commitment to Equality & Accessibility
arenaflex is an E‑Verify participant and fully complies with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer and proudly uphold a policy of nondiscrimination based on age, race, color, national origin, sex, religion, veteran status, disability, sexual orientation, gender identity, genetic information, or any other protected characteristic. As a federal contractor, we maintain robust affirmative‑action programs to promote employment opportunities for minorities, females, disabled individuals, and veterans. Reasonable accommodations are available for candidates with disabilities; please contact us at
[email protected] for assistance.
Ready to Make an Impact?
If you are a detail‑oriented, customer‑focused professional who thrives in a dynamic, mission‑driven environment, we invite you to join arenaflex as a Claims Customer Service Advocate II. Your expertise will directly influence member satisfaction, operational efficiency, and the overall health of our community. Apply today and start a rewarding career where your contributions are valued and your growth is supported.
Apply Now
```