At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers.
When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let's build healthier communities together, join now!
JOB SUMMARY
Responsible for performs accurate and complete process of credentialing data analysis for monitor ongoing process and all type of requirements in accordance with the regulatory agencies and credentialing work plan. Collects statistical data internal and external with the purpose of providing information and recommendations to management for decision-making. If these tasks are not carried out properly, they can lead to other making incorrect decisions and result in a delay in processes and, or more complex services. Looks at the situation or problem comparing it with previous situations to identify a pattern, the root of cause and develop a corrective action plan.
ESSENTIAL FUNCTIONS
- Develop new reports, dashboards, and other means to enable transparency and to monitor credentialing operational processes and to provide timely information to senior management regarding status of compliance with guidelines, rules-regulations and internal policies and procedures and assist with decision-making and tracking accountability.
- Improves credentialing status by analyzing results and monitoring variances. Identify indicators and interpret statistical data to detect, correct and prevent situations that may negatively impact the department’s performance or compliance requirements.
- Collaborates with the automatization of credentialing databases.
- Able to reconcile, identify any outlier indicators and validate data. Monitor’s data quality and consistency and creates reports to proactively address and resolve data quality violations.
- Provide accurate data based on information related to credentialing performed to providers, including Individuals, Hospitals, and Ancillary facilities.
- Prepare and respond to Ad-hoc reporting requests as needed for specific situations, such as other departments, internal or external auditors, and external regulators.
- Provide support and assistance to determine Workplans and be able to adjust them, as necessary.
- Maintain and implement any improvement to the credentialing master reports
- Contribute to team effort by accomplishing related results as needed. Participates in proactive team efforts to achieve departmental and company goals.
EDUCATION
- Bachelor's Degree in Bio Statics or Mathematics
EXPERIENCE
Bachelor’s degree in Biostatistics, Mathematic, Finance or related field, preferable, with one (1) to (3) three years of experience in the Health Insurance Industry preferred.
LICENSES AND CERTIFICATIONS
- None required
COMPETENCIES
- Manages Ambiguity
- Instills Trust
- Collaborates
- Customer Delight
- Action Oriented
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, sex, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug-free company.
Equality Employment Opportunity/Affirmative Action for People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Veterans and Disabled to Apply.