Hybrid Insurance Claims Representative

TPIS•Trujillo Alto, PR

7d•$14•Hybrid

About The Position

We are seeking a Claims Representative Agent to support our Health Insurance client company. If you have experience in a production environment, office setting, or call center, this opportunity could be an excellent fit for you. We are looking for someone who is detail‑oriented, customer‑focused, and ready to contribute in a fast‑paced operational environment.

Requirements

1+ years of experience in a production environment
Proficient in MS Office with solid computer skills (e.g. multiple systems experience, keyboarding skills, Microsoft word, Power Point)
Proficient in verbal and written English skills
Willing or able to work 40 hours / week during standard business operating hours Monday - Friday from 7am - 7pm AST (It may be necessary, given the business need, to work occasional overtime on weekends and holidays)

Nice To Haves

Experience in medical billing or claims
Dental claims experience

Responsibilities

Provide expertise or general claims support by reviewing, researching, processing, and adjusting claims
Handling different work types like claim adjustment work including Calltraks/Onbase
Processing different type of Dental claims on CPS Jacada Platform
Analyze and identify trends and provide reports as necessary
Consistently meet established productivity, schedule adherence and quality standards
Authorizes the appropriate payment or refers claims to investigators for further review
Conducts data entry and claims processing/issues
Handling issues within turnaround standards
Ability to handle most claim types / cases / issues that are submitted to the team you are supporting
Ability handle escalations as needed
Ability to work multiple functions and applications in a day as needed
Communicate any changes in trending of inventory, volumes, and quality remediation
Meet and maintain minimum quality and productivity standards
Other functions may apply