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Insurance Claims Executive Jobs in Puerto Rico (NOW HIRING)

Sonesta International Hotels

Director of Security

San Juan, PR · On-site

  • Medical

  • Dental

  • Vision

  • Life

  • Retirement

  • PTO

... department, insurance agencies to assist in case evaluation, settlement or defense involving ... claims. * Arrange and provide special security services for special events and executives as ...

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Insurance Claims Executive information

What does an insurance claims executive do?

An Insurance Claims Executive is responsible for managing and processing insurance claims from policyholders. They assess the validity of claims by reviewing documentation, investigating circumstances, and liaising with clients and third parties. Their role also includes negotiating settlements, ensuring compliance with policies, and striving to deliver fair and timely resolutions. Insurance Claims Executives often work closely with underwriters, adjusters, and legal teams to resolve complex cases and maintain customer satisfaction.

What are the key skills and qualifications needed to thrive as an insurance claims executive?

To thrive as an Insurance Claims Executive, you need a solid understanding of insurance policies, claims processing, and risk assessment, often supported by a degree in finance, business, or a related field. Familiarity with claims management systems, industry software (such as Guidewire or ClaimCenter), and relevant certifications like AIC (Associate in Claims) is highly valuable. Strong analytical thinking, negotiation skills, and customer service orientation set top performers apart in this role. These skills are crucial for efficiently managing claims, mitigating losses, and ensuring customer satisfaction while adhering to regulatory requirements.

What are some common challenges faced by insurance claims executives during the claims assessment process?

Insurance Claims Executives often encounter challenges such as verifying the authenticity of claims, managing tight deadlines, and communicating complex policy details to clients. Balancing customer empathy with the need for thorough investigation can be demanding, especially when handling multiple claims simultaneously. Additionally, adapting to evolving regulations and using claims management software efficiently are essential to ensure accurate and timely settlements while minimizing fraud risks.

What is the difference between Insurance Claims Executive vs Insurance Claims Adjuster?

AspectInsurance Claims ExecutiveInsurance Claims Adjuster
CredentialsTypically requires insurance or claims certification, relevant experienceRequires claims handling certification, licensing varies by state
Work EnvironmentOffice-based, managerial oversight, client interactionsField or office-based, investigating claims, assessing damages
Employer & Industry UsageInsurance companies, corporate claims departmentsInsurance companies, third-party claims firms

The main difference is that an Insurance Claims Executive often oversees claims processes and manages teams, while an Insurance Claims Adjuster directly investigates and evaluates individual claims. Both roles require relevant certifications and work within insurance companies, but their responsibilities and focus areas differ.

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

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

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

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

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

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

What cities in Puerto Rico are hiring for Insurance Claims Executive jobs?

Cities in Puerto Rico with the most Insurance Claims Executive job openings:

Insurance Claims Executive jobs near you
Infographic showing various Insurance Claims Executive job openings in Puerto Rico as of July 2026, with employment types broken down into 100% Full Time. Highlights an 100% In-person job distribution.

Network Operations Analyst

Grupo Triple-S

Guaynabo, PR • On-site

Full-time

Posted 12 days ago

Job description

Network Operations Analyst
Company: Triple-S Salud
Job Location (Short): Guaynabo, PR
Posting Start Date: 6/2/26
JOB SUMMARY
Responsible for analyzing and translating complex provider network and operational data into actionable insights that support performance improvement and regulatory compliance. This role focuses on evaluating provider network adequacy, access to care, utilization trends, and operational workflows within a healthcare environment. The analyst will design and deliver reports, dashboards, and data visualizations to monitor key performance indicators, including provider availability, geographic access, case turnaround times (TAT), and provider onboarding metrics. This role partners closely with Provider Network, Operations, and Leadership to ensure data-driven visibility into network performance, support strategic decision-making, and continuous improvement initiatives aligned with healthcare regulations, best practices and standards.
ESSENTIAL FUNCTIONS
  • Develops, maintains, and automates new reports, dashboards, and other means to enable transparency and monitor network management operational processes. Provides timely information to management regarding status of compliance with guidelines, rules-regulations and internal policies and procedures and assists with decision-making and tracking accountability.
  • Analyzes provider network adequacy, including geographic distribution, provider-to-member ratios, and compliance with access standards, such as time and distance requirements.
  • Generates reports on provider availability and accessibility by specialty, region, and line of business.
  • Evaluates provider utilization trends, including patterns by specialty, primary care providers (PCPs), and service areas.
  • Monitors and reports on key operational metrics such as case volumes, turnaround times (TAT), provider onboarding timelines, and case closure rates. Track and analyze provider-related interventions, outreach efforts, and network development activities to assess impact on access and performance.
  • Ensures data integrity and consistency across multiple healthcare data sources, including claims, providers data, and operational systems. Monitors data quality and reliability and creates solutions to proactively address and resolve data quality inconsistencies.
  • Supports compliance reporting and audits by ensuring accuracy and completeness of data related to provider networks and access to care.
  • Prepares and responds Ad-Hoc reporting requests as needed for specific situations, such as other departments, auditors, and external regulators.
  • Designs and delivers executive-level dashboards and presentations that communicate key trends, risks, and opportunities related to network performance.
  • Translates complex healthcare data into clear, concise insights for technical and non-technical stakeholders.
  • Continuously enhances reporting capabilities through automation, standardization, and implementation of data analytics best practices.

EDUCATION
  • Bachelor's Degree in Mathematics or Finance

EXPERIENCE
Bachelor's degree in Biostatistics, Mathematic, Finance or related field, preferable, with one (1) to (3) three years of experience in the Health Insurance Industry preferred.
LICENSES AND CERTIFICATIONS
  • None required

COMPETENCIES

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