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Claims Associate Jobs in Puerto Rico (NOW HIRING)

Firstsource

Claims Examiner

Guaynabo, PR · On-site

$21/hr

  • Retirement

  • PTO

Associate degree in Health Information Management, Medical Coding, Healthcare Administration, or a related field (or equivalent experience). Excellent verbal, written, reading, and presentation ...

Alivia Health

PR · On-site

Guaynabo, PR PBM Claims Analyst is responsible for auditing, analyzing, and tracking accounts ... Associate's degree in Medical Billing and Coding, Health Services Administration, Medical Office ...

Grupo Triple-S

PR · On-site

$13 - $17.75/hr

... and claims processes applying various operational procedures and guidelines under general ... Associate's Degree in Administracion de Empresas or Mercadotecnia * Associate Degree in Business ...

New

Elevance Health

PR

$10.50 - $14/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... and claims. Seeks, understands and responds to the needs and expectations of internal and external customers. * Associates in this role are expected to have the ability to multi-task, including ...

Elevance Health

Cust Care Rep I-Bilingual (US)

San Juan, PR · On-site

$15.75 - $21.25/hr

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... and claims. Seeks, understands and responds to the needs and expectations of internal and external customers. * Associates in this role are expected to have the ability to multi-task, including ...

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Claims Associate information

What does a claims associate do?

A claims associate handles claims for an insurance company. As a claims associate, your job duties may include reviewing a customer’s insurance coverage and interviewing those who have filed a claim. Your job is to ensure that a claim is processed correctly, so the customer receives the financial payout to which they are entitled. In this career, you usually work in an office, but you may need to travel to gather information about the claim. There are positions in every insurance industry so that you may work in anything from auto to life insurance. This position requires excellent research and interpersonal skills, and experience in customer service is a plus. Additional qualifications may include an associate degree.

What does a claims associate do?

A Claims Associate is responsible for reviewing, processing, and managing insurance claims submitted by policyholders. Their duties include verifying information, evaluating the validity of claims, and ensuring all necessary documentation is complete. They often communicate with customers, healthcare providers, or other parties to gather additional information and resolve any issues. Claims Associates play a crucial role in ensuring claims are processed accurately and efficiently according to company policies and regulatory guidelines.

What are the key skills and qualifications needed to thrive as a claims associate?

To thrive as a Claims Associate, you need a solid understanding of insurance policies, attention to detail, and basic analytical skills, usually supported by a high school diploma or equivalent. Familiarity with claims management systems, CRM software, and sometimes industry certifications like AIC (Associate in Claims) are commonly required. Strong communication, problem-solving, and customer service abilities set top performers apart. These skills are essential for accurately processing claims, ensuring compliance, and providing a positive experience for clients and policyholders.

What are some common challenges a claims associate may face, and how can they effectively handle them?

Claims Associates often encounter challenges such as managing a high volume of claims, navigating complex policy details, and communicating with clients who may be experiencing stress or frustration. Effectively handling these situations requires strong organizational skills, attention to detail, and clear, empathetic communication. Many Claims Associates find success by proactively prioritizing tasks, seeking guidance from senior team members when needed, and utilizing available technology to streamline documentation and follow-ups.

What is the difference between Claims Associate vs Claims Examiner?

AspectClaims AssociateClaims Examiner
Required CredentialsHigh school diploma or equivalent; some roles may prefer insurance-related certificationsHigh school diploma; insurance certifications like CPCU or similar beneficial
Work EnvironmentOffice setting, interacting with customers and internal teamsOffice setting, reviewing claims and documentation
Employer & Industry UsageInsurance companies, third-party administratorsInsurance companies, adjusting departments
Common Search & ComparisonClaims Associate vs Claims Examiner

The main difference between a Claims Associate and a Claims Examiner lies in their responsibilities. Claims Associates typically handle initial customer interactions and basic claim processing, while Claims Examiners review and assess claims in detail, often making determinations on claim validity. Both roles require similar credentials and work in comparable environments, but Claims Examiners usually have more specialized knowledge and decision-making authority.

Is being a claims associate hard?

Claims associates handle insurance claims processing, which requires attention to detail, strong communication skills, and knowledge of insurance policies. The job can be challenging due to the need for accuracy, meeting deadlines, and managing complex cases, but it is generally manageable with proper training and experience.

What is a claims associate in claims?

A claims associate is a professional who reviews, processes, and manages insurance claims to determine coverage and settlement amounts. They often work with claim documentation, use claims management software, and ensure compliance with company policies and industry regulations.
More about Claims Associate jobs

What are the most commonly searched types of Claims jobs in Puerto Rico?

The most popular types of Claims jobs in Puerto Rico are:

What are popular job titles related to Claims Associate jobs in Puerto Rico?

For Claims Associate jobs in Puerto Rico, the most frequently searched job titles are:

What job categories do people searching Claims Associate jobs in Puerto Rico look for?

The top searched job categories for Claims Associate jobs in Puerto Rico are:

Claims Associate jobs near you

Claims Examiner

Firstsource

Guaynabo, PR • On-site

$21/hr

Full-time

Retirement, PTO

Posted 19 days ago

Firstsource rating

6.5

Company rating: 6.5 out of 10

Based on 57 frontline employees who took The Breakroom Quiz

28th of 71 rated call and contact centers

Job description

We are seeking an experienced Certified Professional Coder (CPC) to support medical record reviews and coding validation activities for U.S. healthcare clients.

This position will play a critical role in reviewing medical documentation associated with claim disputes and determining whether diagnosis codes submitted by providers are appropriate, sufficiently specific, and compliant with applicable coding guidelines.

Key Responsibilities

Review medical records and validate diagnosis and procedure codes.

Ensure coding complies with ICD-10-CM, CPT, HCPCS, CMS, HIPAA, and payer guidelines.

Review claim denials, appeals, audits, and coding disputes.Identify opportunities for more specific diagnosis coding when documentation supports it.

Document coding decisions and collaborate with providers and operations staff.

Maintain coding accuracy, productivity, and confidentiality of PHI.

Qualifications

One of the following certifications: AAPC: CPC / AHIMA: CCS or CCA

At least 2 years of professional medical coding experience.

Call center experience (required).

Experience with: U.S. healthcare reimbursement ; Medical record review ; Medicare, Medicaid, commercial insurance, or managed care ; Clinical documentation review

Proficiency with: ICD-10-CM ; CPT ; HCPCS ; Medical terminology ; Anatomy and physiology ; EHR systems (such as Epic, MEDITECH, eClinicalWorks, 3M Encoder);

Microsoft OfficeExperience with claim denials, appeals, audits, or coding validation.Managed Care or Medicaid coding experience.Associate degree in Health Information Management, Medical Coding, Healthcare Administration, or a related field (or equivalent experience).

Excellent verbal, written, reading, and presentation skills.

Fully bilingual in English and Spanish (required).Intermediate to advanced proficiency in computer applications and Microsoft Office

Availability to work rotating eight (8)-hour shifts in a Monday through Friday operation between 8:00 a.m. and 11:00 p.m. Occasional availability to work weekends and holidays may be required based on operational needs.

Benefits

Opportunities for professional growth and career development.

Leadership and training programs.

Paid time off.

Retirement plan.

The opportunity to be part of a global organization committed to excellence and innovation.

Location: On-site in Guaynabo, Puerto Rico | Hybrid work arrangement available, subject to performance evaluations and operational needs.

Employment Type: Full-Time

Compensation: Starting$21.00 per hour

We are an Equal Employment Opportunity (EEO) employer committed to fostering a diverse and inclusive workplace.

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