Claims Representative - San Juan, PR
About The Position
Optum is seeking a Claims Representative in San Juan, Puerto Rico. The role supports healthcare claims operations by authorizing appropriate payments or referring claims for further investigation, processing claims, and resolving issues within required turnaround standards. The representative may handle a range of claim types, cases, and escalations, and work across multiple functions and applications as needed. The position requires meeting quality and productivity standards, completing assigned development courses and training, and communicating changes in inventory trends, volumes, and quality remediation. An English proficiency assessment is required after application. The role offers performance recognition, clear direction, and development opportunities for other roles. The schedule is 40 hours per week during standard business operating hours Monday through Friday, between 7 a.m. and 7 p.m. AST. Occasional overtime on weekends and holidays may be necessary based on business needs.
Requirements
- At least 1 year of experience in a production environment.
- Proficiency in MS Office and solid computer skills, including experience with multiple systems, keyboarding, Microsoft Word, and PowerPoint.
- Proficient verbal and written English skills.
- Ability to work 40 hours per week during standard business operating hours Monday through Friday, between 7 a.m. and 7 p.m. AST; occasional overtime on weekends and holidays may be necessary.
- Pass an English proficiency assessment after application.
Nice To Haves
- Experience in medical billing or claims.
- Healthcare experience.
Responsibilities
- Authorize appropriate claim payments or refer claims to investigators for further review.
- Perform data entry and claims processing and resolve claims issues.
- Handle issues within required turnaround standards.
- Handle most claim types, cases, and issues submitted to the supported team.
- Handle escalations as needed.
- Work across multiple functions and applications during the day as needed.
- Communicate changes in inventory trends, volumes, and quality remediation.
- Complete required individual development courses and training.
- Meet and maintain minimum quality and productivity standards.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
No Education Listed
