**Experienced Claims Customer Service Advocate III – Complex Claims Resolution and Customer Experience Expert**

At arenaflex, we're dedicated to delivering exceptional customer experiences and providing top-notch claims resolution services. As an Experienced Claims Customer Service Advocate III, you'll play a critical role in ensuring our customers receive prompt, accurate, and courteous responses to their complex claims inquiries. If you're passionate about delivering world-class customer service, have a knack for problem-solving, and thrive in a fast-paced environment, we want to hear from you! **About arenaflex** arenaflex is a leading provider of innovative healthcare solutions, with a rich history spanning over seven decades. As a trusted partner in the South Carolina community, we've built a reputation for excellence, with an A.M. Best rating of A+ (Superior) – the only health insurance company in South Carolina with this distinction. Our commitment to delivering outstanding service to our customers is unmatched, and we're proud to be a strong supporter of our veterans, with many service men and women joining our ranks. **Job Summary** As an Experienced Claims Customer Service Advocate III, you'll be responsible for reviewing complex claims or appeals issues, researching to identify underlying causes, and determining ways to prevent and correct such causes. You'll also identify and report potential fraud and abuse situations, research and respond to complex customer inquiries, and ensure that contract standards and objectives for timeliness, productivity, and quality are met. If you're a customer service expert with a passion for claims resolution, we want to hear from you! **Key Responsibilities** * Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed * Researches to identify underlying causes and determines ways to prevent and correct such causes * Identifies and reports potential fraud and abuse situations * Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity, and quality are met * Handles situations that require adaptation of response or extensive research * Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines * Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes * Ensures claims are processing according to established quality and production standards * Provides feedback to management regarding customer issues * Maintains accurate records concerning issues * Follows through on complaints until resolved or reports to management as needed * Maintains knowledge of procedures and policies * Assists with process improvements by recommending improvements in procedures and policies * Assists in training claims customer service representatives **Essential Qualifications** * High School Diploma or equivalent * 3 years of customer service experience, including 1 year of claims or appeals processing experience * Bachelor's Degree in lieu of work experience * Knowledge of Microsoft Office * Good verbal and written communication skills * Strong customer service skills * Good spelling, punctuation, and grammar skills * Basic business math abilities * Ability to handle confidential or sensitive information with discretion **Preferred Qualifications** * Experience working in a claims or appeals processing environment * Knowledge of healthcare regulations and industry standards * Certification in claims or appeals processing (e.g., CPC, CCA) * Experience with claims management software (e.g., claims system, case management system) **Skills and Competencies** * Excellent communication and interpersonal skills * Strong problem-solving and analytical skills * Ability to work in a fast-paced environment with multiple priorities * Strong attention to detail and organizational skills * Ability to maintain confidentiality and handle sensitive information * Strong customer service skills and a passion for delivering exceptional customer experiences * Ability to work collaboratively with cross-functional teams * Strong analytical and critical thinking skills **Career Growth Opportunities and Learning Benefits** At arenaflex, we're committed to helping our employees grow and develop their careers. As an Experienced Claims Customer Service Advocate III, you'll have opportunities to: * Develop your skills and expertise in claims resolution and customer service * Take on new challenges and responsibilities as you grow in your role * Collaborate with cross-functional teams to drive process improvements and innovation * Participate in training and development programs to enhance your skills and knowledge * Pursue certifications and professional development opportunities to advance your career **Work Environment and Company Culture** arenaflex is a dynamic and inclusive workplace that values diversity, equity, and inclusion. We're committed to creating a work environment that's supportive, collaborative, and fun. As an Experienced Claims Customer Service Advocate III, you'll have the opportunity to work with a talented team of professionals who share your passion for delivering exceptional customer experiences. **Compensation, Perks, and Benefits** We offer a comprehensive benefits package that includes: * Subsidized health plans, dental, and vision coverage * 401(k) retirement savings plan with company match * Life insurance * Paid Time Off (PTO) * On-site cafeterias and fitness centers in major locations * Education Assistance * Service Recognition * National discounts to movies, theaters, zoos, theme parks, and more **How to Apply** If you're a customer service expert with a passion for claims resolution, we want to hear from you! Apply now to join our team of dedicated professionals who are committed to delivering exceptional customer experiences. Apply to this job **Equal Employment Opportunity Statement** arenaflex is an equal opportunity employer and welcomes applications from diverse candidates. We're committed to creating a workplace that's inclusive, equitable, and respectful of all individuals. If you need special assistance or an accommodation while seeking employment, please email [mycareer.help@bcbssc.com](mailto:mycareer.help@bcbssc.com) or call 800-288-2227, ext. 47480 with the nature of your request. Apply for this job