Casualty Manager
Guaynabo, PR · On-site
We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join ...
Casualty Manager
Guaynabo, PR · On-site
We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join ...
PR · On-site
Medical
Basic knowledge of health insurance benefits (Medicare, Medicaid, commercial plans). * Proficiencyin technology tools and computer equipment. * Good keyboard management and data entry skills.
Quick apply
PR · On-site
Medical
Basic knowledge of health insurance benefits (Medicare, Medicaid, commercial plans). * Proficiencyin technology tools and computer equipment. * Good keyboard management and data entry skills.
PR · On-site
$12.50 - $15.75/hr
El Clinical Screener (Evaluador Clínico) proporciona información general y orientación no clínica a los afiliados, incluyendo, entre otros, afiliados de Medicare, Medicaid, planes de salud ...
Quick apply
PR · On-site
$15.50 - $19.50/hr
El Clinical Screener (Evaluador Clínico) proporciona información general y orientación no clínica a los afiliados, incluyendo, entre otros, afiliados de Medicare, Medicaid, planes de salud ...
Quick apply
Provider Navigator
Guaynabo, PR · On-site
We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join ...
Provider Navigator
Guaynabo, PR · On-site
We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses. Let's build healthier communities together, join ...
PR · On-site
$15.50 - $19.50/hr
El Clinical Screener (Evaluador Clínico) proporciona información general y orientación no clínica a los afiliados, incluyendo, entre otros, afiliados de Medicare, Medicaid, planes de salud ...
Quick apply
PR · On-site
$12.50 - $15.75/hr
El Clinical Screener (Evaluador Clínico) proporciona información general y orientación no clínica a los afiliados, incluyendo, entre otros, afiliados de Medicare, Medicaid, planes de salud ...
Quick apply
PR · On-site
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. * In addition, all other duties ...
Quick apply
PR · On-site
Complies with all guidelines established by the Centers for Medicare and Medicaid (CMS) and guidelines set forth by other regulatory agencies, where applicable. * In addition, all other duties ...
PR · On-site
$13 - $17.75/hr
Servimos a más de a más de 1 millón de asegurados en Puerto Rico, a través de nuestras líneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia. Construyamos ...
New
PR · On-site
$13 - $17.75/hr
Servimos a más de a más de 1 millón de asegurados en Puerto Rico, a través de nuestras líneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia. Construyamos ...
New
PR · On-site
Retirement
Preferiblemente, 3 años en Premium Management (Vital y/o Medicare Advantage), incluyendo auditorías y codificación en entornos como planes médicos, grupos y oficinas de salud. Beneficios ...
Quick apply
PR · On-site
Retirement
Preferiblemente, 3 años en Premium Management (Vital y/o Medicare Advantage), incluyendo auditorías y codificación en entornos como planes médicos, grupos y oficinas de salud. Beneficios ...
Remote Bilingual Customer Service Representative
Bayamon, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Bayamon, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
PR · On-site
Conocimiento básico de beneficios de seguros médicos (Medicare, Medicaid, planes comerciales) * Dominio de herramientas tecnológicas y equipos computarizados. * Buen manejo de teclado y entrada de ...
Quick apply
PR · On-site
Conocimiento básico de beneficios de seguros médicos (Medicare, Medicaid, planes comerciales) * Dominio de herramientas tecnológicas y equipos computarizados. * Buen manejo de teclado y entrada de ...
Remote Bilingual Customer Service Representative
Guaynabo, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Guaynabo, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Dorado, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Dorado, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Vega Alta, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Vega Alta, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
PR · On-site
Conocimiento básico de beneficios de seguros médicos (Medicare, Medicaid, planes comerciales) * Dominio de herramientas tecnológicas y equipos computarizados. * Buen manejo de teclado y entrada de ...
Quick apply
PR · On-site
Conocimiento básico de beneficios de seguros médicos (Medicare, Medicaid, planes comerciales) * Dominio de herramientas tecnológicas y equipos computarizados. * Buen manejo de teclado y entrada de ...
Remote Bilingual Customer Service Representative
Ponce, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Ponce, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Corozal, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Corozal, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Cidra, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
Remote Bilingual Customer Service Representative
Cidra, PR · On-site
$13.67/hr
Medical
Dental
Vision
PTO
The calls are related to Assisting members with enrollment into the Medicare plan, Disenrolling them from their plan, processing claims regarding their plan etc. There are plenty of growth ...
PR · On-site
$14.75 - $18.25/hr
Medical
Basic knowledge of health insurance benefits (Medicare, Medicaid, commercial plans). * Proficiency in technology tools and computer equipment. * Good keyboard management and data entry skills.
Quick apply
PR · On-site
$14.75 - $18.25/hr
Medical
Basic knowledge of health insurance benefits (Medicare, Medicaid, commercial plans). * Proficiency in technology tools and computer equipment. * Good keyboard management and data entry skills.
Medicare information
What is a Medicare?
A Medicare job typically involves working with the federal health insurance program that provides coverage for seniors and certain individuals with disabilities. Roles in this field can include customer service representatives, claims processors, billing specialists, and Medicare advisors. Responsibilities often include helping beneficiaries understand their coverage, processing claims, ensuring compliance with regulations, and assisting with enrollment. Many Medicare jobs are found in healthcare companies, government agencies, or insurance providers.
What are the key skills and qualifications needed to thrive in the Medicare position, and why are they important?
To thrive in a Medicare Specialist role, a deep understanding of Medicare regulations, claims processing, and health insurance fundamentals is essential, often requiring a background in healthcare administration or a related field. Familiarity with billing software, claims adjudication systems, and relevant certifications such as Certified Medical Reimbursement Specialist (CMRS) are highly valuable. Strong attention to detail, analytical thinking, and effective communication skills help distinguish top performers. These competencies ensure accurate claim handling, regulatory compliance, and positive interactions with providers and beneficiaries.
What are common challenges faced by Medicare specialists, and how are they addressed on the job?
Medicare Specialists often encounter challenges related to keeping up with frequently changing regulations and managing complex claims issues. Staying current with updates requires ongoing training and close attention to industry bulletins. Handling denials or appeals can be demanding, but most teams provide collaborative support and access to resources for resolving difficult cases. Effective time management and clear communication with both beneficiaries and healthcare providers help streamline processes and ensure compliance. Many organizations also offer opportunities for skill development to help specialists adapt to evolving policies.
What are popular job titles related to Medicare jobs in Puerto Rico?
For Medicare jobs in Puerto Rico, the most frequently searched job titles are:
What job categories do people searching Medicare jobs in Puerto Rico look for?
The top searched job categories for Medicare jobs in Puerto Rico are:
Full-time
Posted 10 days ago
Job description
Casualty Manager
Company: Triple-S Propiedad
Job Location (Short): Guaynabo, PR
Posting Start Date: 8/3/26
At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
JOB SUMMARY
In charge of leading our casualty claims management efforts, overseeing all aspects of claims handling, from investigation to resolution. Is responsible for managing high-risk claims, ensuring compliance with company policies and procedures, and supervising internal and external personnel. As a key member of our claims leadership team, the Casualty Claims Manager will collaborate with internal stakeholders, including the Legal Manager, to drive tactical plans and make strategic decisions that minimize reputational risk and financial exposure. Provides strategic direction to drive tactical plans of the company, in addition to administrative responsibilities and development of its employees.
ESSENTIAL FUNCTIONS
EDUCATION
EXPERIENCE
LICENSES AND CERTIFICATIONS
COMPETENCIES
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.
Company: Triple-S Propiedad
Job Location (Short): Guaynabo, PR
Posting Start Date: 8/3/26
At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
JOB SUMMARY
In charge of leading our casualty claims management efforts, overseeing all aspects of claims handling, from investigation to resolution. Is responsible for managing high-risk claims, ensuring compliance with company policies and procedures, and supervising internal and external personnel. As a key member of our claims leadership team, the Casualty Claims Manager will collaborate with internal stakeholders, including the Legal Manager, to drive tactical plans and make strategic decisions that minimize reputational risk and financial exposure. Provides strategic direction to drive tactical plans of the company, in addition to administrative responsibilities and development of its employees.
ESSENTIAL FUNCTIONS
- Supervise and manage legal and non-legal adjusters in the casualty/legal claims area.
- Supervise coverage analysis for all litigated claims and coordinating support for coverage analysis in non-litigated claims.
- Oversee effective investigations of claims, ensuring thorough, accurate and timely reports.
- Manage delegated monetary authority for claims resolution.
- Collaborate with the Legal Manager to develop and implement litigation strategies, including adjustments, expert resources, and budgeting.
- Approve determination of appeal resources, in collaboration with the Legal Manager.
- Oversee approval of billing generated by vendors in claims.
- Manage adequacy of indemnity reserves for casualty/legal claims.
- Administer reporting to reinsurers on claims as required.
EDUCATION
- Bachelor's Degree
EXPERIENCE
- Bachelor's degree from an accredited institution with 10 years of experience in Claims adjustment, vast and extensive knowledge of Property and Casualty Policies and Regulations.
- Puerto Rico All Lines Insurance Adjuster License.
LICENSES AND CERTIFICATIONS
COMPETENCIES
- Customer Delight
- Data Driven Insights
- Develops Talent
- Financial & Business Acumen
- One Company Mindset
- Practical Knowledge in Tech
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.