En Triple-S, estamos comprometidos con brindar experiencias laborales significativas para nuestra Gente Valiosa. Nos esforzamos por la excelencia en todo lo que hacemos, desde la forma en que trabajamos juntos hasta la forma en que servimos a nuestros clientes.
Al unirte a Triple-S, serás pieza clave para nuestros esfuerzos de brindar atención médica accesible y de alta calidad, así como también contribuirás a nuestro propósito de habilitar vidas saludables. Servimos a más de a más de 1 millón de asegurados en Puerto Rico, a través de nuestras líneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia.
Construyamos comunidades saludables juntos. ¡Únete a nosotros!
JOB SUMMARY
ESSENTIAL FUNCTIONS
- Analyzes, reconciles, and processes transactions at the insured's subscription level, such as additions, terminations and maintenance that include, but are not limited to, demographic changes, changes in coverage and indicators.
- Applies subscription rules and established procedures to subscription requests received.
- Reviews the transactions processed to ensure the accuracy of the information configured according to the requests received.
- Analyzes error reports resulting from the eligibility processes and corrects entries to the system in accordance with the request by affiliate.
- Performs maintenance associated with the Coordination of Benefits process (COB), Medicare as a secondary payer (MSP) and third-party liability insurance (TPL) applying the established rules.
- Analyzes reports and, if necessary, corrects the activation of policyholders in the PBM systems.
- Evaluates and determines the action to be taken on requests from the insured, in accordance with applicable regulations.
- Comply with the established and metric indicators (MTM, internal, external and compliance). Inform to management any situation that may affect compliance or impact execution.
- Reconciles, identify, documents, and submits retroactive eligibility transactions through Reeds and Associates, processor designated by CMS.
- Reconciles, identifies, analyzes, and corrects eligibility or discrepancies in eligibility, demographic data and indicators that affect the eligibility of the insured with the services of the delegated entities, CMS and ASES premium.
- Reconciles, identifies, analyzes, and corrects late registration penalty discrepancies between CMS and the subscription system.
- Receives, evaluates, and responds to the decisions of Maximus Federal Services and performs the corresponding transactions in the subscription system.
- Other tasks as assigned by the Management and that are essential.
EDUCATION
- Associate's Degree in Administracion de Empresas
Associate Degree (60-64 college credits) in Business Administration, preferable, with one (1) to three (3) years of related experience, preferably with health insurance industry. Or three (3) to five (5) years work experience in lieu of.
LICENSES AND CERTIFICATIONS
- No requerido
COMPETENCIES
- Maneja la Ambigüedad
- Inspira confianza
- Colaboración
- Deleite al Cliente
- Orientado a la Acción
Es política de la compañía buscar a los(las) solicitantes calificados(as) para puestos en toda la empresa sin distinción de raza, color, origen nacional, religión, sexo, identidad de género, orientación sexual real o percibida, estado civil, condición social, las ideologías políticas, edad, discapacidad física o mental, condición de veterano o cualquier otra característica protegida por la ley.
Empresa libre de drogas. Patrono con Igualdad de Oportunidad de Empleo”. Acción Afirmativa para Veteranos y Personas con Discapacidad". Patrono con E-Verify para verificar la elegibilidad de empleo de todos los/las nuevos(as) empleados(as).
Invitamos a las mujeres, veteranos y discapacitados a participar.