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
ESSENTIAL FUNCTIONS
- Generate and analyze data through COB and medical claims reports to identify Commercial, Medicare and Medicaid overpayments.
- Compile documents and prepare defense to response to Medicare Commercial Repayment Center.
- Evaluate payments for Medicare related to the debts of Coordination of Benefit claims.
- Analize pharmacy reports sent by others Plan insurances and analyze internal overpayments of pharmacy claims.
- Create recovery COB adjustment petitions, follow up and reconcile data upon completion Process, analyze and deliver the Cost Avoidance reports in collaboration with the Sales Group Associate and Marketing Department.
- Analyze Plan Documents, Certification of Benefits and Policies for the resolution of debts.
- Provide training to other departments as Member Management, Claims and Service Management to give tools for the appropriate manage of the Coordination of Benefit end to end process.
- Coordinate meeting with Commercial Repayment Center Supervisors to discuss Demand Letters. Coordinates with Finance on demand checks for CRC payments.
- Validate the quality of the coordination of benefits on QNXT enrollment module to ensure the integrity of the payment.
EDUCATION
- Bachelor's Degree
- Associate's Degree
EXPERIENCE
Bachelor’s Degree with 1 to 3 years of related experience working in COB, claims evaluation or medical billing or Associate degree (60-64) college credits (AD) with (3) to (5) years of experience in COB, claims evaluation or medical billing.
LICENSES AND CERTIFICATIONS
- None required
COMPETENCIES
- Manages Ambiguity
- Instills Trust
- Collaborates
- Customer Delight (Employee)
- 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.