- 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
- Walmart (Caguas, PR)
- …company-paid life insurance. Paid time off benefits include parental leave, family care leave, bereavement, jury duty, and voting. Other benefits include short-term ... and long-term disability, company discounts, Military Leave Pay, adoption and surrogacy expense reimbursement, and more. You will also receive PTO and/or PPTO that can be used for vacation, sick leave, holidays, or other purposes. The amount you receive… more
- Evertec Group, LLC (PR)
- Claims Specialist Business Solutions & Merchant Acquiring Puerto Rico General Responsibilities Responsible for providing excellent customer care with a ... policies and procedures, as applicable. Education and Experience Required * Associate or Bachelor degree in Business Administration, Management, Accounting, or… more
- Evolent (San Juan, PR)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...our specialty programs and administrative platform. **Role Overview** The Associate Director role on Client Analytics will support both… more
- Walmart (Fajardo, 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
- 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
- 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
- Otsuka America Pharmaceutical Inc. (San Juan, PR)
- …Specialty Medicine products at different stages of development for a global health- care market. The duties assigned to the Director, Global Clinical Development ... research experience (as a general guideline, 1-3 years for Associate Director level; 3-6 years for Director is typically...you will be reimbursed, this is not Otsuka. These claims are fraudulent and you are strongly advised to… 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)
- …and/or other end compliant inquiries. + Has 6-7 direct reports including Associate Directors, Managers, and Senior Professionals + Provides strategic direction and ... operational efficiencies + Collaborates with upstream business partners such as Claims , Clinical Guidance, and the Provider Network to identify opportunities and… more
- Evolent (San Juan, PR)
- …people with most complex and costly health conditions. Working across specialties and primary care , we seek to connect the pieces of fragmented health care ... system and ensure people get the same level of care and compassion we would want for our loved...development efforts. **What You Will Be Doing:** + Analyze claims and authorization data to identify trends, calculate cost… 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
- CenterWell (San Juan, PR)
- …us put health first** As a Sr. Business Intelligence Engineer for CenterWell Primary Care , you can directly impact patient care and outcomes through your work. ... your technical skills while also contributing to a larger mission of enhancing patient care and health outcomes. It's not just about numbers and datasets; it's about… 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
- 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
- CenterWell (San Juan, PR)
- …Contracting Professional ensures contract compliance and performs analysis regarding pharmacy claims and network composition to identify contracting needs to provide ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… 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
- Humana (San Juan, PR)
- …on. This role will largely be using Oracle SQL to pull medical and Rx claims , membership, and premium related data to provide reports to Medicaid Finance CFOs as ... (collectively, "Humana") offers competitive benefits that support whole-person well-being. Associate benefits are designed to encourage personal wellness and smart… more