Claims Processing Representative 3 - San Juan PR

Profile

Description

The Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. May apply intermediate mathematical skills.

Responsibilities

The Claims Processing Representative 3 determines whether to return, deny, or pay claims following organizational policies and procedures. 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


HS Diploma
High level of emotional intelligence
Medical claims processing and interpretation experience
Analytical and problem solving skills
Proficient in MS Word, Excel, PP and Outlook
Work At Home requirements (Temporary due to COVID-19): Must have the ability to provide a high speed DSL or cable modem for a home office (Satellite and Wireless Internet service is NOT allowed for this role). A minimum standard speed for optimal performance of 10x1 (10mbs download x 1mbs upload) is required. A dedicated space lacking ongoing interruptions to protect member PHI / HIPAA information


Preferred Qualifications


Associate or Bachelor's Degree
Bilingual English/Spanish. Candidate selected will not be communicating in English with members.
Working knowledge of Claims Cost Management
Experience in a role requiring problem solving skills
Working knowledge of Coordination of Benefits (COB)
Working knowledge of Medicare Secondary Payer (MSP)
Working knowledge PMHS
Experience with CRM.


Additional information


Schedule: Monday to Friday from 7:30 am - 4:30 pm. Overtime, needed to work some weekends.
Training: 2 months -Virtual
Work Location (Address): This permanent job is working from Home temporary due to Covid 19 emergency. This position will deploy to the following location at a future date: 3rd floor, 383 Ave. Roosevelt, San Juan , PR 00919


Scheduled Weekly Hours

40

Company info

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