Grievances & Appeals Representative

This is a fully remote position, open to applicants in Puerto Rico.

📋 Description

• Oversee client denials and concerns by performing a thorough analytical review of clinical documentation.

• Provide final determinations based on acquired skills and collaboration with clinical stakeholders.

• Execute advanced administrative, operational, and customer support tasks.

• Assist members via phone to promote and support quality-related objectives.

• Investigate and resolve issues faced by members and practitioners.

• Utilize discretion and sound judgment in prioritizing requests and interpreting procedures.

⛳️ Requirements

• Must be a resident of Puerto Rico.

• Bilingual in English and Spanish.

• Minimum of two (2) years of experience in customer service.

• Experience in the healthcare industry or a medical setting.

• Familiarity with working in a production-driven environment.

• Skilled in data entry and record management.

• Intermediate proficiency in Microsoft Word and Excel.

🏝️ Benefits

• Medical, dental, and vision insurance.

• 401(k) retirement savings plan.

• Paid time off, including company holidays, personal holidays, and paid parental and caregiver leave.

• Short-term and long-term disability coverage.

• Life insurance.