Remote National Customer Service & Claims Representative – Compassionate Healthcare Support at arenaflex

Why arenaflex?

At arenaflex, we are redefining the way millions of Americans experience health insurance. As a leading third‑party administrator (TPA) in the nation’s most dynamic health‑care ecosystem, we partner with health plans, providers, and members to deliver higher‑quality care, lower costs, and broader access. Our mission is simple yet powerful: help people live healthier lives while making the health system work better for everyone. Whether you are a seasoned call‑center professional or just starting your career, arenaflex offers a supportive, growth‑focused environment where your compassion and curiosity can thrive.

Position Overview

We are seeking a Remote National Customer Service & Claims Representative who will serve as the friendly voice and knowledgeable guide for our members and their families. In this dual‑role, you will handle inbound calls, answer eligibility and benefits questions, and process health‑care claims with precision and empathy. The position is fully remote, allowing you to work from any U.S. location that meets our high‑speed internet standards, while adhering to a consistent 8‑hour shift schedule (8:00 AM – 4:30 PM CST, Monday‑Friday).

Key Responsibilities

• Answer incoming member calls, quickly identifying the nature of the request—benefits eligibility, billing inquiries, authorizations, or explanation of benefits (EOBs).
• Ask targeted, open‑ended questions and practice active listening to capture accurate information in our CRM and claims platforms.
• Own each member issue from start to finish, delivering real‑time resolutions or coordinated follow‑up that exceeds expectations.
• Research, review, and process health‑care claims submitted by members and providers, navigating multiple internal systems to verify pricing, prior authorizations, and applicable benefits.
• Apply the correct benefit rules, state mandates, CMS/Medicare guidelines, and plan documents to ensure fair, thorough claim adjudication.
• Communicate clearly with members and providers, translating complex medical terminology into simple, actionable language.
• Collaborate with internal teams—claims, billing, compliance, and provider relations—to resolve escalated issues promptly.
• Meet or exceed performance metrics for efficiency, accuracy, quality, member satisfaction, and attendance.
• Participate in ongoing training sessions, webinars, and skill‑building workshops to stay current on policy changes and industry best practices.

Essential Qualifications

• High school diploma, GED, or equivalent experience.
• Minimum of 1 year experience in a call‑center environment and 1 year in a customer‑service role.
• Familiarity with health‑care or health‑insurance terminology, including basic medical terminology.
• Demonstrated ability to thrive in a metric‑driven workplace, consistently meeting productivity and quality targets.
• Flexibility to work any 8‑hour shift within the 8:00 AM – 4:30 PM CST window, regardless of your time zone, and occasional overtime as business needs dictate.
• Must be 18 years of age or older.

Preferred Qualifications & Additional Experience

• Prior experience processing health‑care claims or working directly with providers (physicians, clinics, hospitals).
• Certification or coursework in medical terminology, health‑care administration, or related fields.
• Experience using multiple claim‑processing platforms, CRM tools, or data‑validation software.
• Demonstrated success in a remote work setting, including a dedicated home office that meets privacy and security standards.

Core Skills & Competencies

• Compassionate Communication: Ability to build rapport quickly, listen empathetically, and convey information in a respectful, clear manner.
• Analytical Problem‑Solving: Skilled at diagnosing issues, researching data, and recommending solutions that balance member needs with policy requirements.
• Technical Proficiency: Comfortable navigating multiple computer systems, entering data accurately, and learning new software tools.
• Adaptability: Flexibility to adjust communication style to diverse member personalities and to handle high‑volume, fast‑paced environments.
• Conflict Management: Proven ability to de‑escalate tense situations, maintain composure, and achieve positive outcomes.
• Time Management: Efficiently prioritize tasks, meet deadlines, and balance simultaneous responsibilities without sacrificing quality.

Telecommuting Requirements

• Secure, dedicated workspace separate from household traffic to protect confidential member information.
• High‑speed internet connection approved by arenaflex, meeting minimum bandwidth standards for voice and data transmission.
• Ability to safeguard all company‑sensitive documents, whether physical or digital, in accordance with arenaflex’s data‑privacy policies.

Compensation, Perks & Benefits

arenaflex offers a competitive hourly wage ranging from $16.00 – $28.27 (based on location, experience, and qualifications). In addition to base pay, you will be eligible for:

• Comprehensive health, dental, and vision insurance plans.
• Retirement savings options, including 401(k) matching contributions.
• Paid time off, holidays, and flexible scheduling to support work‑life balance.
• Performance‑based incentives, recognition programs, and opportunities for equity participation.
• Continuous learning resources—online courses, certifications, and mentorship programs.
• Access to a robust employee assistance program (EAP) for personal and professional support.

Career Growth & Development

arenaflex is experiencing record‑breaking growth, and we invest heavily in internal talent. As a Remote Customer Service & Claims Representative, you will have clear pathways to advance into roles such as:

• Senior Claims Analyst
• Team Lead – Member Services
• Quality Assurance Specialist
• Training & Development Coordinator
• Operations Management positions

Our structured onboarding program includes several weeks of paid, instructor‑led training aligned with your shift schedule, followed by ongoing coaching and performance feedback. You will also have access to cross‑functional projects that broaden your skill set and increase visibility across the organization.

Work Environment & Culture at arenaflex

Our culture is built on three pillars: Compassion, Innovation, and Inclusion. We celebrate diverse perspectives, encourage curiosity, and empower every employee to make a meaningful impact on members’ lives. Even though you will be working remotely, arenaflex fosters a vibrant virtual community through regular team huddles, digital coffee chats, and employee resource groups. We are a drug‑free workplace, and we uphold the highest standards of ethical conduct and compliance.

Application Process

If you are ready to bring your empathy, problem‑solving talent, and dedication to a purpose‑driven organization, we invite you to apply today. Follow the link below to submit your resume and a brief cover letter outlining why you are the ideal fit for this role.

Apply Now – Join arenaflex

Equal Opportunity Employer

arenaflex is an Equal Employment Opportunity and Affirmative Action employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, veteran status, disability, age, or any other characteristic protected by law. We are committed to creating a workplace that reflects the diversity of the communities we serve.

Join Us in Making a Difference

Every call you answer, every claim you process, and every member you assist contributes to a healthier, more equitable society. At arenaflex, you will not only develop a rewarding career—you will help shape the future of health‑care delivery for millions of Americans. Take the first step toward a fulfilling, purpose‑driven journey. Apply today and become part of the arenaflex family.