- Lincoln Financial (San Juan, PR)
- …**Requisition #:** 74647 **The Role at a Glance** We are excited to bring on a Claims Customer Care Associate to join our claimant excellence team supporting ... coaching and development to perform in this fast-paced environment. As a Claims Customer Care Associate , you will be responsible for answering claimants… more
- Otsuka America Pharmaceutical Inc. (San Juan, PR)
- …Otsuka Precision Health is a health experience company that brings personalized care within reach through products and services for mental and physical well-being. ... **About This Role** We are seeking a strategic, entrepreneurial Associate Director to drive the evolution of OPH's connected...solutions that enhance peoples' lives, we also work to care for our teammates' professional and personal growth and… more
- Intermountain Health (San Juan, PR)
- **Job Description:** Responsible for the timely follow-up of claims billed and resolution of accounts. Oversees the account receivables and maintains ... detailed/accurate account documentation. Follow up on open claims thoroughly, accurately, promptly, and with all supporting documentation. Responsible for… more
- Walgreens (Bayamon, PR)
- …pharmacist, including those to physicians. + Processes (corrects and resubmits) manual claims for third party program prescription services in a timely and efficient ... Maintains knowledge of Company asset protection techniques, and files claims for warehouse overages (merchandise received, but not billed), shortages… more
- Walmart (Cayey, PR)
- …Merchandise Assembly, Grocery Unloading and Stocking, Remodel, Receiving, Price Change, and Claims . Benefits & perks At Walmart, we offer competitive pay as well ... company-paid life insurance. Paid time off benefits include parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term… more
- Humana (San Juan, PR)
- …first** The Medical Director relies on medical background and reviews health claims . The Medical Director work assignments involve moderately complex to complex ... and judgement to make determinations whether requested services, requested level of care , and/or requested site of service should be authorized. All work occurs… more
- Otsuka America Pharmaceutical Inc. (San Juan, PR)
- …Specialty Medicine products at different stages of development for a global health- care market. The specific duties assigned to the Director, Global Clinical ... research experience (as a general guideline, 1-3 years for Associate Director level; 3-6 years for Director and 6-9...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… more
- Humana (San Juan, PR)
- …this role, you will conduct quality reviews of coding processes within the Claims Cost Management organization, including offshore and vendor partners, with a focus ... and well-grounded medical coding auditor to quality review the inpatient hospital claims for proper reimbursement, handle provider disputes in a result-oriented and… more
- Humana (San Juan, PR)
- …to assignments. The Senior Encounter Data Management professional ensures data integrity for claims errors that result from the data exchange between Humana and its ... to make an impact** **Required Qualifications** **5 years of medical claims processing/auditing or encounter data management experience** **Demonstrated deep dive… more
- Humana (San Juan, PR)
- …responsible for administering complex Medicaid provider reimbursement methodologies. The associate will support existing Medicaid business and expansion into new ... closely with IT, the pricing software vendor, CIS BSS, Medicaid operations, claims operations, and other business teams involved in the administration of Medicaid… more
- Humana (San Juan, PR)
- …external vendors to support quality measure improvement activities. + Investigates claims and medical records to identify opportunities for quality improvement and ... + One (1) year of working in a health care environment/managed care setting. + Proficiency in...skills combined with an understanding of medical record and claims documentation requirements. **Preferred Qualifications** + Master's Degree. +… more
- Humana (San Juan, PR)
- …The Encounter Data Management Professional ensures data integrity for claims errors. The Encounter Data Management Professional work assignments are ... make an impact** **Required Qualifications** + 1 - 5 years or more of claims processing experience + Minimum of 1 year experience in conducting thorough root cause… more
- Humana (San Juan, PR)
- …is committed to advancing the employment experience and vitality of the associate community. Through offerings anchored in a whole-person view of human well-being, ... network relationships with large national providers. Ensure adequate coverage of primary care , specialty and ancillary services for Humana to meet both regulatory… more
- Humana (San Juan, PR)
- …populations served in target growth markets. Candidates will possess Medicaid managed care operations expertise and have experience in designing solutions for key ... member, products and benefits, and health plan administration portfolios (provider, claims , etc.), with areas of focus including Enrollment, Member Experience,… more
- Humana (San Juan, PR)
- …5 or more years' experience working in a Compliance-related or managed care -related field or pharmacy + Experience working with regulatory agencies + Knowledgeable ... improvement and metrics development + Knowledgeable in regulations governing health care industries + Strong communication skills + Experience with pharmacy… more
- Humana (San Juan, PR)
- …The Corporate Medical Director relies on medical background and reviews health claims and preservice appeals. The Corporate Medical Director works on problems of ... + 5 years of established clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and or Commercial products + Must be passionate… more
- Humana (San Juan, PR)
- …The Corporate Medical Director (CMD) relies on medical background to review health claims and preservice appeals. The Corporate Medical Director works on problems of ... years of established, post-residency clinical experience + Knowledge of the managed care industry including Medicare, Medicaid and/or Commercial products + Must be… more