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
Performs sponsor (employer) configuration interpreting documents provided as part of the Health Insurance Contract and or Financial Proposal and related documentation. Applies established rules and procedures to ensure configuration accuracy. Actively interacts with Configuration, Sales, Underwriting and Finance divisions to ensure that configuration is performed in accordance with signed Sales Contracts and Renewal Documents.
ESSENTIAL FUNCTIONS
- Configure, create and renew group structures (Sponsor-Orgpolicies) in QNXT system in accordance with the results of the Renewal and Sales contract documents.
- Update Sponsor Demographic data, rules and other information relevant and required as part of the Sponsor set up.
- Perform massive transactions for member’s benefits-coverages updates.
- Analyze ID Card Sponsor-Orgpolicies requirements for Commercial lines of business to create and modify configurations. Also validate and coordinate sample approvals from Sales and Corporate Accounts Administration.
- Assign and validate premium rate tables, applicable to rated orgpolicies (Audit Premium C9).
- Analyze, review, and validate the information configured in the system to ensure that all elements are completed and accurate.
- Comply with key performance indicators, run reports and data queries to support the validation.
- Process changes and maintenances to existing Sponsors upon request, updates to orgpolicy AR accounts and requests for new Banks Routing Numbers.
- Interact with Sales and Renewal executives and other parties as Verification and SIAV Department, involved in the configuration process to clarify any doubts related the negotiation and other matters.
- Participation in core system upgrades, disaster recovery test exercises and expert users’ validations.
- Advice management of any situation that might affect duties.
- Analize and create new model structures for Vital, TS Directo Individual, Medicare Advantage and other special negotiations.
EDUCATION
- Bachelor's Degree in Business Administration
- Associate's Degree in Business Administration
EXPERIENCE
Bachelor’s Degree in Business Administration with 1 year in Sales and Renewal, Customer Service or Enrollment with applicable software experience as an end-user in the health insurance industry preferable. Or Associate Degree (60-64 college credits) in Business Administration with 2 to 3 years in Sales and Renewal, Customer Service or Enrollment with applicable software experience as an end-user in the health insurance industry. Or 3 to 5 years of this experience in lieu of.
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.