Claims Review Representative 3/TPA/PSM - RENEWABLE CONTRACT POSITION WITH Full Benefits Bilingual San Juan PR

Profile

Description

The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

The Claims Review Representative 3 partners with professional staff on pre-screening review by applying guidance, and making an appropriate decision which may include interpretation of provider information or data. Decisions are typically focus on methods, tactics and processes for completing administrative tasks/projects. Regularly exercises discretion and judgment in prioritizing requests and interpreting and adapting procedures, processes and techniques, and works under limited guidance due to previous experience/breadth and depth of knowledge of administrative processes and organizational knowledge.

Required Qualifications


High School Diploma or equivalent
1-3 years of technical experience
Strong and proven experience with processing and adjudicating medical claims
Proficiency in Microsoft Office applications including Word, Excel and Outlook
Working knowledge of computers or a demonstrated technical aptitude
Ability to quickly learn new systems
Ability to manage and prioritize tasks based on business need
Bilingual Spanish/English. (Intermediate level in English) Candidate selected will not be communicating in English with members.


Preferred Qualifications


Associate's or Bachelor's Degree
Experience in working under processes that require production (Ex. Prepay and Post Pay processes)
Knowledge with CPT and ICD9 terminology/codes


Additional information


Contact Position : This is a renewable contract position with full benefits.
Schedule: Mo nday to Friday from 8 am to 5 pm.
Training: Webex Training
Work Location (Address): This RENEWABLE CONTRACT POSITION WITH Full Benefits is working from Home temporary due to Covid 19 emergency. This position will deploy to the following location at a future date: Chardon Ave Hato Rey, PR 00918


Scheduled Weekly Hours

40

Company info

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