PR · On-site
Guaynabo, PR PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role focuses ...
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PR · On-site
Guaynabo, PR PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role focuses ...
Accounts Receivable Analyst
San Juan, PR · Remote
$23.50 - $30/hr
Support team members in resolving complex claims. * Support engagement management in pulling ... Provide account information to payers and required and resolve issues related to eligibility ...
Accounts Receivable Analyst
San Juan, PR · Remote
$23.50 - $30/hr
Support team members in resolving complex claims. * Support engagement management in pulling ... Provide account information to payers and required and resolve issues related to eligibility ...
Cost Manager
San Juan, PR · Hybrid
$130K/yr
Manages cost control, valuations, reporting and final account processes with clarity and accuracy. * Oversees claims, change assessments and key project certifications through strong commercial ...
Cost Manager
San Juan, PR · Hybrid
$130K/yr
Manages cost control, valuations, reporting and final account processes with clarity and accuracy. * Oversees claims, change assessments and key project certifications through strong commercial ...
Senior Cost Manager
San Juan, PR · Hybrid
$130K/yr
Manages cost control, valuations, reporting and final account processes with clarity and accuracy. * Oversees claims, change assessments and key project certifications through strong commercial ...
Senior Cost Manager
San Juan, PR · Hybrid
$130K/yr
Manages cost control, valuations, reporting and final account processes with clarity and accuracy. * Oversees claims, change assessments and key project certifications through strong commercial ...
Casualty Jr. Underwriter
San Juan, PR · On-site
... and top management. * Assist Operations Department in policy issuance as well as support Claims Department in the event of a claim under one of their accounts in order to interpret underwriting ...
Casualty Jr. Underwriter
San Juan, PR · On-site
... and top management. * Assist Operations Department in policy issuance as well as support Claims Department in the event of a claim under one of their accounts in order to interpret underwriting ...
Casualty Jr. Underwriter
San Juan, PR · On-site
... and top management. * Assist Operations Department in policy issuance as well as support Claims Department in the event of a claim under one of their accounts in order to interpret underwriting ...
Casualty Jr. Underwriter
San Juan, PR · On-site
... and top management. * Assist Operations Department in policy issuance as well as support Claims Department in the event of a claim under one of their accounts in order to interpret underwriting ...
Epic Resolute Hospital Billing Associate Analyst
San Juan, PR · Hybrid
$47K - $62K/yr
Provide account information to payers and required and resolve issues related to eligibility ... Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or ...
Epic Resolute Hospital Billing Associate Analyst
San Juan, PR · Hybrid
$47K - $62K/yr
Provide account information to payers and required and resolve issues related to eligibility ... Rebill corrected claims and route issues to coding, billing, credentialing, denials, and/or ...
PR · On-site
Properly enter test claims to verify business rules set up in the system. * Perform quality ... Works with the Benefit team, Account Management and Quality Internal Audits to evaluate complex ...
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Patient Collection Associate (San Juan, PR)
$17.25 - $23.50/hr
Manages and report monthly budget input for assigned accounts and other credit duties. This ... claims. * In charge of Refunds audit cases documentation submissions to bank. (Evertec audit ...
Patient Collection Associate (San Juan, PR)
$17.25 - $23.50/hr
Manages and report monthly budget input for assigned accounts and other credit duties. This ... claims. * In charge of Refunds audit cases documentation submissions to bank. (Evertec audit ...
Hospital Billing Coordinator
San Juan, PR · Remote
$50K - $60K/yr
Review patient accounts, charge details, coding inputs, and supporting documentation for billing ... Prepare and submit hospital claims to commercial, government, and other third-party payers in ...
Hospital Billing Coordinator
San Juan, PR · Remote
$50K - $60K/yr
Review patient accounts, charge details, coding inputs, and supporting documentation for billing ... Prepare and submit hospital claims to commercial, government, and other third-party payers in ...
Hospital Billing Operator
San Juan, PR · Remote
$18 - $23/hr
Review patient accounts, charge details, coding inputs, and supporting documentation for billing ... Prepare and submit hospital claims to commercial, government, and other third-party payers in ...
Hospital Billing Operator
San Juan, PR · Remote
$18 - $23/hr
Review patient accounts, charge details, coding inputs, and supporting documentation for billing ... Prepare and submit hospital claims to commercial, government, and other third-party payers in ...
Patient Collection Associate (San Juan, PR)
San Juan, PR · On-site
$17.25 - $23.50/hr
Manages and report monthly budget input for assigned accounts and other credit duties. This ... claims. * In charge of Refunds audit cases documentation submissions to bank. (Evertec audit ...
Patient Collection Associate (San Juan, PR)
San Juan, PR · On-site
$17.25 - $23.50/hr
Manages and report monthly budget input for assigned accounts and other credit duties. This ... claims. * In charge of Refunds audit cases documentation submissions to bank. (Evertec audit ...
PR · On-site
Responsibilities 1. Accurately code and submit claims to insurance companies and government payers ... 4. Monitor and analyze accounts receivable, follow up on overdue payments, and implement ...
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PR · On-site
Responsibilities 1. Accurately code and submit claims to insurance companies and government payers ... 4. Monitor and analyze accounts receivable, follow up on overdue payments, and implement ...
PR · On-site
Responsibilities 1. Accurately code and submit claims to insurance companies and government payers ... 4. Monitor and analyze accounts receivable, follow up on overdue payments, and implement ...
Quick apply
PR · On-site
Responsibilities 1. Accurately code and submit claims to insurance companies and government payers ... 4. Monitor and analyze accounts receivable, follow up on overdue payments, and implement ...
Cost Engineering Lead
Carolina, PR · Hybrid
Evaluates contractor claims for delays and additional costs, providing informed recommendations ... Ensures final accounts are properly negotiated, agreed and closed out. * Leads and manages a team ...
Cost Engineering Lead
Carolina, PR · Hybrid
Evaluates contractor claims for delays and additional costs, providing informed recommendations ... Ensures final accounts are properly negotiated, agreed and closed out. * Leads and manages a team ...
Operations Supervisor
$19 - $21/hr
Reviews open sales orders, open purchase orders, open vendor claims, and open transfers. * Confers ... managing freight bills/expenses, accounts payable discrepancies. * Trains and ensures all assigned ...
Operations Supervisor
$19 - $21/hr
Reviews open sales orders, open purchase orders, open vendor claims, and open transfers. * Confers ... managing freight bills/expenses, accounts payable discrepancies. * Trains and ensures all assigned ...
Operations Supervisor
Guaynabo, PR · On-site
$19 - $21/hr
Reviews open sales orders, open purchase orders, open vendor claims, and open transfers. * Confers ... managing freight bills/expenses, accounts payable discrepancies. * Trains and ensures all assigned ...
Operations Supervisor
Guaynabo, PR · On-site
$19 - $21/hr
Reviews open sales orders, open purchase orders, open vendor claims, and open transfers. * Confers ... managing freight bills/expenses, accounts payable discrepancies. * Trains and ensures all assigned ...
Operations Supervisor
$19 - $21/hr
Reviews open sales orders, open purchase orders, open vendor claims, and open transfers. * Confers ... managing freight bills/expenses, accounts payable discrepancies. * Trains and ensures all assigned ...
Operations Supervisor
$19 - $21/hr
Reviews open sales orders, open purchase orders, open vendor claims, and open transfers. * Confers ... managing freight bills/expenses, accounts payable discrepancies. * Trains and ensures all assigned ...
Customer Engagement Rep I
Guaynabo, PR · On-site
... register claims, cancel accounts, and more.Guide customers on products, services, and pricing ... Ability to set priorities and manage time effectively.Teamwork and ability to work under pressure.
Customer Engagement Rep I
Guaynabo, PR · On-site
... register claims, cancel accounts, and more.Guide customers on products, services, and pricing ... Ability to set priorities and manage time effectively.Teamwork and ability to work under pressure.
Customer Engagement Rep II
Ceiba, PR · On-site
... register claims, cancel accounts, and more.Guide customers on products, services, and pricing ... Ability to set priorities and manage time effectively.Teamwork and ability to work under pressure.
Customer Engagement Rep II
Ceiba, PR · On-site
... register claims, cancel accounts, and more.Guide customers on products, services, and pricing ... Ability to set priorities and manage time effectively.Teamwork and ability to work under pressure.
Claims Account Manager information
How much does an account manager get paid?
Claims account managers typically earn a median annual salary between $50,000 and $70,000, depending on experience, location, and the size of the organization. Salaries can increase with certifications, specialized skills, and years of experience in the insurance or claims industry.
How does a Claims Account Manager typically collaborate with other departments to resolve complex claims issues?
Claims Account Managers often work closely with underwriting, legal, and risk management teams to address complex claims. This collaboration may involve reviewing policy details, analyzing risk factors, and ensuring compliance with regulations. Effective communication and teamwork are essential, as Claims Account Managers act as the main point of contact between clients and internal departments, helping to expedite resolutions and maintain client satisfaction.
What is the highest paid position in insurance?
In the insurance industry, executive roles such as Chief Executive Officer (CEO), Chief Underwriting Officer, and Chief Risk Officer tend to be the highest paid positions. These roles require extensive experience, leadership skills, and often advanced certifications, and they oversee company strategy, underwriting, and risk management.
What jobs pay 500,000 a year in the US?
Claims Account Managers typically do not earn $500,000 annually; such high salaries are usually found in executive roles, specialized medical professionals, or successful entrepreneurs. High compensation in these areas often requires extensive experience, advanced certifications, or ownership of a business. Most roles with this level of income are rare and often involve performance-based bonuses or profit sharing.
What is the difference between Claims Account Manager vs Claims Adjuster?
| Claims Account Manager | Claims Adjuster |
|---|---|
| Focuses on managing client accounts, policy renewals, and customer relationships | Evaluates insurance claims, investigates damages, and determines claim validity |
| Requires strong communication, customer service, and account management skills | Requires claims investigation, assessment, and knowledge of insurance policies |
| Works primarily in client-facing roles within insurance companies or brokers | Works in claims departments, often in an office or field environment |
While both roles are integral to the insurance industry, a Claims Account Manager primarily manages client relationships and policy accounts, whereas a Claims Adjuster focuses on investigating and settling individual claims. Understanding these differences helps job seekers identify the right career path within insurance claims roles.
What does a claims account manager do?
A claims account manager oversees insurance claims processes, ensuring accurate and timely resolution of claims for clients. They review claim details, communicate with policyholders and adjusters, and use claims management software to track case progress, often requiring strong communication and organizational skills. Their goal is to maintain customer satisfaction while minimizing company losses.
What are the key skills and qualifications needed to thrive as a Claims Account Manager, and why are they important?
To thrive as a Claims Account Manager, you need a solid understanding of insurance policies, claims processing, and account management, typically backed by a bachelor's degree in business or a related field. Familiarity with claims management software, CRM systems, and industry certifications like AINS or CPCU is highly beneficial. Strong negotiation, problem-solving, and client communication skills set top performers apart in this role. These skills and qualifications ensure efficient claims resolution, high client satisfaction, and effective risk management for both the company and its clients.
What job categories do people searching Claims Account Manager jobs in Puerto Rico look for? The top searched job categories for Claims Account Manager jobs in Puerto Rico are:
What cities in Puerto Rico are hiring for Claims Account Manager jobs? Cities in Puerto Rico with the most Claims Account Manager job openings:
Full-time
Posted 17 days ago
Job description
Location: Guaynabo, PR
PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts receivable related to Pharmacy Benefit Managers (PBMs) at a specialty pharmacy. This role focuses primarily on reviewing and validating payments, identifying discrepancies, and analyzing unpaid payments. The analyst’s primary responsibility is to audit, document, and report findings to the teams.
Responsibilities:
- Conduct daily audits of PBM-related accounts receivable to identify outstanding balances.
- Analyze claims that have been paid, partially paid, or unpaid, as processed in “View Response.”
- Review PBM remittances, reports, and electronic files to verify the accuracy of payments.
- Identify discrepancies between amounts billed, amounts paid, and contractually expected amounts.
- Clearly and thoroughly document audit findings in the established systems.
- Refer cases of errors, partial payments, or required adjustments to the Operations team.
- Follow up on referred cases until resolution, without performing reprocessing.
- Prepare lists and reports of audited and referred PBM accounts and discuss them with your Supervisor.
- Identify recurring patterns of errors, delays, or non-compliance by PBMs.
- Communicate financial trends and risks to the appropriate Supervisor or Manager.
- Support internal and external audits related to PBM accounts receivable.
Requirements:
- Associate's degree in Medical Billing and Coding, Health Services Administration, Medical Office Administration, Medical Records, or related fields in the healthcare sector.
***Equal Opportunity Employer M/F/V/D**