Remote Healthcare Customer Service Representative – Claims Support, Member Inquiries & Provider Relations Specialist (Work From Home, Florida Residents)

Join arenaflex: Where Compassion Meets Innovation in Healthcare Support

At arenaflex, we believe that every interaction has the power to transform someone's experience with healthcare. As a forward-thinking organization dedicated to making health services more personal, accessible, and affordable, arenaflex brings a human-centered approach to every customer touchpoint. Our purpose is simple yet profound: putting heart into every moment of your health journey. We are committed to delivering enhanced, human-centric healthcare support for a rapidly changing world, anchored in a culture where empathy, innovation, and excellence converge.

Our "Heart At Work" behaviors empower every team member to play a meaningful role in transforming our organizational culture and accelerating our ability to deliver innovative solutions. When you join arenaflex, you become part of a mission-driven community that values your contributions, nurtures your professional growth, and recognizes the profound impact your work has on the lives of members, providers, and communities across the country.

We are currently seeking a dedicated, detail-oriented, and customer-focused Remote Healthcare Customer Service Representative to join our dynamic Claims Inquiry and Claims Research team. This is an exciting opportunity to build a meaningful career from the comfort of your home while making a tangible difference in the healthcare experience of countless individuals.

Position Overview

This fully remote role is based in the State of Florida and involves providing exceptional customer service support to high-volume inbound calls from members, healthcare providers, and plan sponsors. As a vital member of the arenaflex customer service team, you will be responsible for answering questions, resolving complex issues, triaging rework to appropriate staff, and conducting extensive claims research across multiple platforms to assist providers with payment inquiries and benefit-related questions.

The ideal candidate thrives in a fast-paced, transaction-driven environment and demonstrates outstanding critical thinking skills, empathy, and a genuine desire to help others navigate the often-complex world of healthcare claims and benefits.

Key Responsibilities

• Customer Inquiry Resolution: Respond to incoming phone calls and written correspondence from members, providers, and plan sponsors. Answer questions accurately, resolve issues efficiently, and triage any resulting rework to the appropriate internal teams for follow-up.
• Claims Research and Support: Conduct extensive research on multiple platforms to assist healthcare providers with payment questions, claim statuses, and benefit determinations. Serve as a knowledgeable resource for high-volume inbound provider calls on the Claims Inquiry and Claims Research team.
• Proactive Information Sharing: Anticipate customer needs by providing related information they may not have considered, such as additional plan details, benefit plan specifics, member self-service tools, and online resources that empower them to manage their healthcare independently.
• Financial Decision-Making: Utilize the customer service threshold framework to make appropriate financial decisions that resolve member issues fairly and in accordance with company policies and contractual obligations.
• Member Rights Education: Clearly explain members' rights and responsibilities in accordance with their specific plan contracts, ensuring transparency and fostering trust throughout every interaction.
• Claims Processing Support: Process claim referrals, new claim handoffs, nurse reviews, complaints (from both members and providers), and grievance and appeals submissions via the target system with accuracy and attention to detail.
• Provider Education and Self-Service Promotion: Educate and assist providers on the full range of self-service options available, helping them become more independent and efficient. Provide guidance on credentialing, re-credentialing, and contracting questions and issues.
• Audit Support: Assist in compiling claim data and documentation for customer audits, ensuring accuracy and completeness of all records.
• Eligibility and Coverage Verification: Determine medical necessity, identify applicable coverage provisions, and verify member plan eligibility as it relates to incoming correspondence and internal referrals.
• Documentation and Compliance: Maintain thorough, accurate documentation of all customer interactions, decisions, and outcomes in accordance with company standards and regulatory requirements.

Training and Schedule Information

• Training Period: Must be able to attend four (4) weeks of virtual training between the hours of 8:00 AM and 5:00 PM EST. Training is comprehensive and designed to set you up for long-term success.
• Permanent Schedule: After successful completion of training, the permanent schedule is Monday through Friday, with shifts that can start as early as 8:00 AM EST and end as late as 7:00 PM EST.
• Work Environment: This is a 100% remote, work-from-home position. You must reside full-time in the State of Florida.

Required Qualifications

• Residency Requirement: Must live in the State of Florida on a full-time basis.
• Technical Proficiency: Familiarity with Microsoft Office products (Word, Excel, Outlook, PowerPoint) is required.
• Industry Experience: Prior experience working in a highly transactional call center environment is essential.
• Customer Service Excellence: Demonstrated excellence in customer service delivery with strong critical thinking and problem-solving abilities.
• Internet Connectivity: High-speed internet access with a minimum of 25 Mbps download speed and a consistent, reliable connection.
• Wired Connection Requirement: Your work location must be set up with a direct, wired connection to your router (NOT Wi-Fi). arenaflex provides a 6½-foot long ethernet cord; however, if your workspace is located farther from the router, you will be required to provide your own ethernet cable.
• Education: High School diploma or GED equivalent is required.

Preferred Qualifications

• Previous experience in healthcare, insurance, claims processing, or a related field.
• Familiarity with medical terminology, CPT codes, ICD-10 codes, and healthcare billing processes.
• Experience working with claims management systems or customer relationship management (CRM) platforms.
• Bilingual or multilingual capabilities (Spanish language skills are particularly valued given Florida's diverse population).
• Post-secondary education in healthcare administration, business, communications, or a related discipline.
• Demonstrated ability to handle escalations with professionalism, empathy, and effective de-escalation techniques.

Essential Skills and Competencies

To thrive in this role at arenaflex, you will need a balanced combination of technical knowledge, interpersonal abilities, and personal attributes, including:

• Communication Skills: Exceptional verbal and written communication skills with the ability to explain complex information clearly and compassionately.
• Active Listening: Genuine ability to listen attentively, understand customer concerns, and respond with empathy and accuracy.
• Problem-Solving: Strong analytical and critical thinking skills to research issues thoroughly and identify effective solutions.
• Adaptability: Comfortable working in a dynamic, evolving environment with changing priorities, policies, and customer needs.
• Time Management: Ability to manage multiple tasks, prioritize effectively, and meet performance metrics in a fast-paced setting.
• Resilience: Emotional intelligence and the ability to handle difficult conversations with professionalism and composure.
• Team Collaboration: A collaborative mindset with the ability to work effectively with cross-functional teams and contribute to a positive team culture.
• Attention to Detail: Meticulous attention to detail and commitment to accuracy in all documentation and decision-making.
• Technical Aptitude: Comfort with learning and navigating multiple software platforms, databases, and digital tools.

Career Growth and Development Opportunities at arenaflex

At arenaflex, we believe that investing in our employees' growth is essential to our collective success. When you join our team, you gain access to a wide range of professional development resources, including:

• Tuition reimbursement and education assistance programs to support continued learning.
• Free development courses covering leadership, technical skills, customer service excellence, and industry-specific knowledge.
• Clear career advancement pathways, with opportunities to grow into senior customer service roles, team lead positions, quality assurance, training, and management.
• Mentorship programs that pair you with experienced professionals who can guide your career journey.
• Cross-functional project opportunities that allow you to expand your skills and visibility within the organization.
• Performance-based promotions and regular career development conversations with leadership.

Our Company Culture

arenaflex is more than just a workplace—it is a community built on shared values, mutual respect, and a deep commitment to making a difference. Our culture is defined by:

• Purpose-Driven Work: Every role at arenaflex contributes meaningfully to our mission of making healthcare more personal, convenient, and affordable.
• Inclusivity and Belonging: We celebrate diversity and are committed to creating an inclusive environment where every voice is heard, valued, and respected.
• Work-Life Balance: We understand the importance of flexibility and well-being, offering remote work arrangements and supportive policies that help our employees thrive both professionally and personally.
• Recognition and Appreciation: We believe in recognizing the hard work and achievements of our team members through formal recognition programs and everyday appreciation.
• Innovation and Continuous Improvement: We encourage curiosity, creative thinking, and the pursuit of better ways to serve our customers and communities.

Compensation and Benefits

arenaflex offers a competitive compensation package and a comprehensive benefits program designed to support your health, financial security, and overall well-being.

Pay Range: The typical hourly pay range for this role is $17.00 to $25.15. The actual base hourly rate offered will depend on a variety of factors, including relevant experience, education, geographic location, and other pertinent considerations.

Comprehensive Benefits Include

• Full range of medical, dental, and vision insurance benefits.
• Eligibility to enroll in the company's 401(k) retirement savings plan with potential employer matching contributions.
• Access to an Employee Stock Purchase Plan for eligible employees.
• Company-provided, fully-paid term life insurance plan for eligible employees.
• Short-term and long-term disability benefits.
• Numerous well-being programs designed to support mental, emotional, and physical health.
• Education assistance programs and free professional development courses.
• Generous employee discount programs and access to partner discount programs.
• Paid Time Off (PTO) and vacation pay, in addition to paid holidays throughout the calendar year.
• Sick time and other time-off benefits provided in accordance with applicable state laws and company policies.

How to Apply

If you are a Florida-based customer service professional with a passion for helping others, a knack for problem-solving, and a desire to build a rewarding career in healthcare, we would love to hear from you. This is your opportunity to join a purpose-driven organization that truly values its employees and is committed to making a positive impact on the lives of millions.

Bring your skills, your compassion, and your drive to arenaflex. Apply today to take the next step in your career and become part of a team that puts heart into everything we do.

arenaflex is an equal opportunity employer. We celebrate diversity and are committed to creating an inclusive environment for all employees.