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Claims Analyst

Date Posted
13th September 2017
Healthcare & Medical
Job Type
San Juan, PR
Not Disclosed

Job Summary

Adecco is in search of a Claims Analyst for a client in the San Juan Metro area.

Job Description

  • Analyze claims filed by policyholders or beneficiaries, identify that the information is true, process documentation and adjusted according to the conditions and terms of the issued covered notify customers and the determination made to finalize the evaluation process.
  • Establish the methods used for obtaining information, whether inquiries, call or issuing statements to meet the requirements; document the file system and operational processes performed and can provide support for audit processes.
  • Review and approve claims according to established parameters to achieve the completion of the evaluation process and issuing payments to policyholders within the stipulated time.
  • Documenting the work done by worksheets so that they can be reviewed, approved and used to measure the development of knowledge, quality and clarity of the work performed.
  • Complete sheet where the number of cases evaluated daily to establish comparative metrics evolution individual or group level and if it is within the expected parameters are quantified.
  • Require, report or share relevant information with other departments to meet the requirements of the processes established by the policies, the Company, the Office of the Commissioner of Insurance, reinsurance or other regulatory bodies.
Experience and Education Level:
  • Bachelor related area; 
  • 1 to 2 years experience with similar responsibilities. 
  • Courses in medical terminology and / or Medical Billing; or equivalent combination of education and experience. 
  • HIPAA certification.
  • Courses to consider: medical diagnoses ICD-9, ICD-10 (International Classification of Diseases), and procedures CPT (Current Procedural Terminology) coding and medical services HCPCS (Healthcare Common Procedure Coding System).
  • Experience in managing medical records, hospital bills or medical offices (Form 1500, Medicare, etc.). 
  • Experience in managing documents of the ESF, Social Security and others.
Skills and Abilities:
  • Ability to read, write and speak English.
  • Excellent verbal skills and written communication.
  • Basic knowledge of MS Office (Word, Excel, PowerPoint, Outlook, etc.) and Windows Explorer.
  • Good interpersonal skills.
  • Attention to detail.
  • Ability to handle multiple tasks simultaneously.
  • Knowledge and skill in the use of computers, adapting to new technology, keeps abreast with the changes quickly learns programs, use computer to improve productivity.

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