San Juan, PR · On-site
$16.75 - $20.25/hr
... that claims are correctly and timely adjudicated. Essential Functions: 1. Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner. 2. ...
Quick apply
San Juan, PR · On-site
$16.75 - $20.25/hr
... that claims are correctly and timely adjudicated. Essential Functions: 1. Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner. 2. ...
San Juan, PR · On-site
$57.86/hr
Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported * Maintain standards for productivity and accuracy. Standards ...
New
San Juan, PR · On-site
$57.86/hr
Perform clinical review of professional (or facility) claims vs. medical records to determine if the claim is supported or unsupported * Maintain standards for productivity and accuracy. Standards ...
New
San Juan, PR · On-site
$17.25 - $23.50/hr
The Associate, Delinquency Management (Loss Mitigation) contributes to the success of Mortgage ... Prepare, submit, and follow up on investor claims after Loss Mitigation alternatives are executed ...
New
San Juan, PR · On-site
$17.25 - $23.50/hr
The Associate, Delinquency Management (Loss Mitigation) contributes to the success of Mortgage ... Prepare, submit, and follow up on investor claims after Loss Mitigation alternatives are executed ...
New
San Juan, PR · On-site
$17.25 - $23.50/hr
The Associate, Delinquency Management (Loss Mitigation) contributes to the success of Mortgage ... Prepare, submit, and follow up on investor claims after Loss Mitigation alternatives are executed ...
New
San Juan, PR · On-site
$17.25 - $23.50/hr
The Associate, Delinquency Management (Loss Mitigation) contributes to the success of Mortgage ... Prepare, submit, and follow up on investor claims after Loss Mitigation alternatives are executed ...
New
Knowledge in the management of computer systems and keyboarding. * Experience handling claims and verifying policies. * Experience in customer service. * Knowledge in the preparation of reports and ...
Quick apply
Knowledge in the management of computer systems and keyboarding. * Experience handling claims and verifying policies. * Experience in customer service. * Knowledge in the preparation of reports and ...
San Juan, PR · On-site
$95 - $130/hr
Coordinate efforts with external service providers, including actuaries, auditors, investment managers, brokers, claims adjusters, and outside counsel, to proactively meet client needs. * Collaborate ...
San Juan, PR · On-site
$95 - $130/hr
Coordinate efforts with external service providers, including actuaries, auditors, investment managers, brokers, claims adjusters, and outside counsel, to proactively meet client needs. * Collaborate ...
San Juan, PR · On-site
$90 - $120/hr
Manage and maintain all required insurance policies and process claims. * Ensure compliance with all lender and insurance covenants. * Manage relationships with key stakeholders including landowners ...
San Juan, PR · On-site
$90 - $120/hr
Manage and maintain all required insurance policies and process claims. * Ensure compliance with all lender and insurance covenants. * Manage relationships with key stakeholders including landowners ...
Carolina, PR · On-site
$56.45 - $69/hr
Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ... Manages the maintenance, housekeeping, and improvement of the pharmacy department including repairs ...
Carolina, PR · On-site
$56.45 - $69/hr
Ensures insurance claims are processed accurately to prevent payment rejections. Resolves patient ... Manages the maintenance, housekeeping, and improvement of the pharmacy department including repairs ...
Manage and support processes related to: * Workers' compensation claims * Unemployment claims and inquiries * Leaves of absence (FMLA, state paid leave, disability, and company leaves) * Coordinate ...
Manage and support processes related to: * Workers' compensation claims * Unemployment claims and inquiries * Leaves of absence (FMLA, state paid leave, disability, and company leaves) * Coordinate ...
Manage and support processes related to: * Workers' compensation claims * Unemployment claims and inquiries * Leaves of absence (FMLA, state paid leave, disability, and company leaves) * Coordinate ...
Manage and support processes related to: * Workers' compensation claims * Unemployment claims and inquiries * Leaves of absence (FMLA, state paid leave, disability, and company leaves) * Coordinate ...
Guaynabo, PR · On-site
... claims, patient management systems, or other regulated healthcare environments. * PMP or another recognized project management certification preferred. * Ability to coordinate, negotiate with, and ...
Quick apply
Guaynabo, PR · On-site
... claims, patient management systems, or other regulated healthcare environments. * PMP or another recognized project management certification preferred. * Ability to coordinate, negotiate with, and ...
Guaynabo, PR · On-site
... claims, patient management systems, or other regulated healthcare environments. * PMP or another recognized project management certification preferred. * Ability to coordinate, negotiate with, and ...
Quick apply
Guaynabo, PR · On-site
... claims, patient management systems, or other regulated healthcare environments. * PMP or another recognized project management certification preferred. * Ability to coordinate, negotiate with, and ...
Carolina, PR · On-site
$160 - $230/hr
Manage project scope, schedule, budget, quality, and risk throughout the project lifecycle ... Review contractor progress, change requests, claims, and payment applications. * Conduct regular ...
Carolina, PR · On-site
$160 - $230/hr
Manage project scope, schedule, budget, quality, and risk throughout the project lifecycle ... Review contractor progress, change requests, claims, and payment applications. * Conduct regular ...
Guaynabo, PR · On-site
$18 - $23.25/hr
Coordinate with internal departments (Claims, Credentialing, Utilization Management, Compliance, IT) to resolve complex issues. * Track and document provider cases through resolution within CRM or ...
Guaynabo, PR · On-site
$18 - $23.25/hr
Coordinate with internal departments (Claims, Credentialing, Utilization Management, Compliance, IT) to resolve complex issues. * Track and document provider cases through resolution within CRM or ...
Carolina, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Carolina, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Carolina, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Carolina, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Carolina, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Carolina, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Manage project scope, schedule, budget, quality, and risk throughout the project lifecycle ... Review contractor progress, change requests, claims, and payment applications. * Conduct regular ...
Manage project scope, schedule, budget, quality, and risk throughout the project lifecycle ... Review contractor progress, change requests, claims, and payment applications. * Conduct regular ...
Guaynabo, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
Guaynabo, PR · On-site
Ensures the accurate processing of insurance claims to resolve customer issues and prevent payment ... Manages Community Outreach Portal and coordinates and, at the direction of the Pharmacy Manager ...
| Aspect | Claims Manager | Claims Adjuster |
|---|---|---|
| Credentials | Typically requires a bachelor’s degree, industry certifications (e.g., CPCU), and management experience | Usually requires a high school diploma or bachelor’s degree, with certifications like AIC or CPCU preferred |
| Work Environment | Oversees claims departments, manages teams, and develops policies within insurance companies | Evaluates individual claims, investigates damages, and determines settlement amounts |
| Employer & Industry Usage | Commonly employed in insurance companies, handling claims processes and team management | Found in insurance firms, adjusting claims directly with policyholders and providers |
In summary, Claims Managers oversee the claims process and manage teams, requiring leadership skills and industry certifications. Claims Adjusters focus on evaluating individual claims, investigating damages, and determining payouts. Both roles are essential in the insurance industry but differ in scope and responsibilities.
The most popular types of Claims jobs in Puerto Rico are:
For Claims Manager jobs in Puerto Rico, the most frequently searched job titles are:
The top searched job categories for Claims Manager jobs in Puerto Rico are:
Cities in Puerto Rico with the most Claims Manager job openings:
$16.75 - $20.25/hr
Full-time
Re-posted 12 days ago
Position Summary:
The Health Professional 1-Pharmacy Call Center Representative manages telephone calls from pharmacies and providers related to pharmacy benefits, authorization requests, drug use review, among others, to ensure that claims are correctly and timely adjudicated.
Essential Functions:
1. Answers and manages telephone calls from pharmacies and providers in a timely, confidential and courteous manner.
2. Documents calls and/or drug requests with complete follow-up history of the patient through electronic records.
3. Provides orientation to pharmacies regarding pharmacy benefits.
4. Performs system overrides (e.g., prior authorization) on the PBM claims processing system to ensure that claims are
correctly adjudicated.
5. Assists pharmacies claim processing.
6. Assist in the training of pharmacy representatives.
7. Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable.
8. In addition, all other duties assigned by the manager and/or supervisor.
Education:
Experience:
· Minimum 2 years’ experience in retail pharmacy preferred.
Knowledge:
· Basic knowledge of physical and mental pharmacotherapies, in order to make accurate assessments of clinical cases.
· Personal computer experience should include working with Microsoft Word, Excel, Power Point and Outlook at the intermediate level at a minimum.
