Part-Time Customer Service Advocate I – Claims Adjudication & Member Support Specialist (Remote within Richland County Area)

Join arenaflex: Where Compassion Meets Excellence in Healthcare Customer Service

Are you passionate about delivering exceptional service while making a meaningful difference in people’s lives? arenaflex is seeking a dedicated and detail-oriented Part-Time Customer Service Advocate I – Claims Adjudication & Member Support Specialist to join our dynamic claims operations team. This is an exciting opportunity to become part of a respected organization with deep community roots and a forward-thinking approach to healthcare administration. If you thrive in a structured yet supportive environment where accuracy, empathy, and professional growth are equally valued, we want to hear from you.

For more than seven decades, arenaflex has remained a pillar in the healthcare and insurance landscape, serving millions of members across multiple states. As one of the nation’s leading administrators of government contracts, we operate one of the most sophisticated data processing centers in the Southeast, supporting the needs of more than 20 million Medicare beneficiaries nationwide. Our continued success is built on a foundation of integrity, innovation, and an unwavering commitment to outstanding service. When you join arenaflex, you join a family of companies dedicated to transforming the healthcare experience for providers, members, and communities alike.

Position Overview

As a Customer Service Advocate I at arenaflex, you will serve as a critical touchpoint for our members and healthcare providers, responding to routine inquiries with professionalism and accuracy. Your primary responsibilities will include reviewing and adjudicating claims, processing non-medical appeals, identifying incorrectly processed claims, and completing necessary adjustments and reprocessing actions. You will follow established organizational policies and procedures while ensuring that all contract standards and quality objectives are consistently met.

This part-time role is based remotely within a two-hour radius of our Percival Road office in Richland County, offering flexibility with scheduled hours ranging from 20 to 38 per week. The schedule may include evenings and weekends, providing an excellent work-life balance for individuals seeking meaningful part-time employment in the healthcare industry.

Key Responsibilities

• Customer Inquiry Management: Respond promptly and professionally to written and telephone inquiries following established desk procedures, ensuring that all interactions meet contractual standards for timeliness, productivity, and quality.
• Accurate Documentation: Document all member and provider inquiries thoroughly and accurately within the appropriate systems, creating a clear audit trail for future reference and compliance purposes.
• Claims Review and Adjudication: Examine, review, and adjudicate claims and/or non-medical appeals in accordance with business and contract regulations, internal standards, and established examining guidelines.
• Adjustment and Reprocessing: Identify incorrectly processed claims and execute necessary adjustments and reprocessing actions according to department guidelines and quality standards.
• Data Entry and Coding Verification: Enter claims into the claim system after verifying the correct coding of procedures and diagnosis codes, ensuring data integrity throughout the process.
• Quality and Production Standards: Ensure all claims are processed in alignment with established quality benchmarks and production targets, contributing to overall departmental efficiency.
• Escalation Management: Identify complaints and inquiries of a complex nature that cannot be resolved through standard desk procedures and guidelines, referring these matters to a lead or manager for timely resolution.
• Fraud and Error Reporting: Identify and promptly report suspected fraudulent activities and system errors to the appropriate departments, supporting organizational integrity and compliance efforts.

Essential Qualifications

To qualify for this position, candidates must possess the following:

• Educational Background: A High School Diploma OR equivalent is required. Candidates may also qualify with a Bachelor’s Degree in lieu of work experience.
• Professional Experience: A minimum of one year of experience in claims processing, appeals processing, customer service, or a related support area.
• Communication Skills: Strong verbal and written communication skills, with the ability to convey complex information clearly and compassionately.
• Customer Service Excellence: Demonstrated ability to deliver high-quality customer service with empathy, patience, and professionalism.
• Attention to Detail: Excellent spelling, punctuation, and grammar skills, along with basic business math proficiency for accurate claims processing.
• Confidentiality: Ability to handle confidential or sensitive information with the utmost discretion and integrity.
• Technical Proficiency: Working knowledge of Microsoft Office applications, including Word, Excel, and Outlook.

Preferred Qualifications

• Prior teaching or training experience, demonstrating the ability to educate and mentor others.
• Experience working in a healthcare, insurance, or government contracting environment.
• Familiarity with claims processing systems and medical coding terminology.
• Strong problem-solving skills with the ability to navigate complex inquiries.

Skills and Competencies for Success

Successful candidates will demonstrate a unique blend of analytical thinking, interpersonal skills, and operational discipline. Key competencies include:

• Critical Thinking: The ability to assess claims and inquiries methodically, identifying discrepancies and determining appropriate actions.
• Adaptability: Comfort working in a fast-paced environment with evolving priorities and shifting schedules.
• Team Collaboration: A cooperative spirit with the willingness to support colleagues and contribute to collective success.
• Time Management: The ability to manage multiple tasks efficiently while maintaining high standards of accuracy.
• Regulatory Awareness: An understanding of, or willingness to learn, healthcare regulations, compliance standards, and contract requirements.

Career Growth and Learning Opportunities

At arenaflex, we believe in investing in our team members’ professional development. As a part-time Customer Service Advocate I, you will gain invaluable experience in claims adjudication, customer relationship management, and healthcare operations. We offer pathways for advancement into senior claims examiner roles, team lead positions, and specialized areas such as fraud investigation, quality assurance, and training. Our supportive leadership team is committed to mentoring employees and providing resources for continued education, certification support, and skill-building workshops.

Work Environment and Company Culture

arenaflex fosters a culture of respect, collaboration, and continuous improvement. Our team members enjoy a professional yet welcoming atmosphere where diversity is celebrated, and every voice is heard. We understand that our employees are our greatest asset, and we are dedicated to creating an environment where you can thrive both personally and professionally. With flexible scheduling options, remote work capabilities for candidates within the Richland County radius, and a commitment to work-life balance, arenaflex is an employer of choice for individuals seeking meaningful part-time careers in healthcare administration.

Compensation, Perks, and Benefits

While specific compensation details will be discussed during the interview process, arenaflex offers a competitive part-time compensation package that reflects your skills and experience. Our benefits offerings may include:

• Competitive hourly wage with opportunities for performance-based incentives
• Flexible scheduling to accommodate your lifestyle
• Comprehensive training and onboarding programs
• Access to employee assistance programs and wellness resources
• Professional development opportunities and career advancement pathways
• A supportive, inclusive workplace culture
• Potential eligibility for retirement savings plans and other benefits based on hours worked

Equal Employment Opportunity at arenaflex

arenaflex and our subsidiary companies maintain a continuing policy of nondiscrimination in employment. We are committed to promoting employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information, or any other legally protected status. As a federal contractor, arenaflex maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals, and veterans.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities. If you need special assistance or an accommodation while seeking employment, please reach out to our recruiting team, and we will make a determination regarding your request on a case-by-case basis.

What to Expect Next

After submitting your application, our recruiting team will review your resume to ensure you meet the qualifications for this role. This may include a brief telephone interview or email communication to verify resume specifics and discuss your availability and salary requirements. Management will conduct interviews with candidates who qualify, with prioritization given to those who demonstrate the preferred qualifications outlined above.

Take the Next Step in Your Career

If you are committed to delivering outstanding service, passionate about healthcare, and looking for a rewarding part-time opportunity with a company that values your contributions, arenaflex is the place for you. Join a team where your work directly impacts the lives of millions of members, where your growth is supported, and where your dedication is recognized and rewarded.

Apply today and become part of the arenaflex family. We look forward to welcoming you aboard!