Case Review Representative

OncoHealth • Guaynabo, PR

8d • Hybrid

About The Position

The Case Review Representative serves as the first point of contact and intake for calls from members and providers. The role resolves tier-one issues, including user resets, provider data management, fax and letter receipt, and general questions. The representative also triages inbound calls and emails, routes case-specific inquiries to appropriate team members, handles fax intake and labeling, creates prior authorizations, and triages request and claims processing issues to health plans as needed. Quality Performance Program outreach is conducted when assigned.

This position requires flexibility to work rotational shifts during company office hours, generally Monday through Friday between 8:00 a.m. and 8:00 p.m. EST and Saturdays between 8:30 a.m. and 5:00 p.m. EST. Hours may change or extend based on operational needs. Puerto Rico team members must report to the office at least twice per month, with advance notice, and may work remotely from home on other days. Employees may also choose to work from the office daily.

Requirements

• Fully bilingual in English and Spanish.
• At least 2 years of administrative experience and/or customer service experience, or relevant educational attainment.
• Skills for implementing systems to support program effectiveness and productivity.
• Proficiency in the MS Office Suite.

Nice To Haves

• College degree or relevant experience preferred.
• Remote or hybrid work experience preferred.

Responsibilities

• Handle intake for calls from members and providers and resolve tier-one issues, including user resets, provider data management, fax and letter receipt, and general questions.
• Perform fax intake and labeling.
• Create prior authorizations.
• Conduct Quality Performance Program outreach when assigned.
• Triage and manage inbound calls, route case-specific calls to the appropriate team member, and resolve tier-one issues.
• Triage and manage inbound emails from health plan clients, route case-specific emails to the appropriate team member, and resolve tier-one issues.
• Triage request and claims processing issues to health plans as needed.
• Work rotational shifts to cover operational needs during the stated office hours.

Benefits

• Full benefit package beginning on the first day.
• Company bonus.
• Access to modern, engaging offices and a collaborative environment with social activities and community events.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: No Education Listed