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Description The Utilization Management Nurse 2 utilizes clinical nursing skills to support the coordination, documentation and communication of medical services and/or benefit administration determinations. The Utilization Management Nurse 2 work assignments ..
... Review Representative 3 performs advanced administrative/operational/customer support duties that require independent ... experience• CIS/ CIS Pro experience• Bilingual English/Spanish Additional information• Schedule: Monday ... the situation, and will adjust..
... Contacts Representative 3 performs advanced administrative/operational/customer support duties that require independent ... a timely basis to achieve service and quality standards. Decisions are ... inbound call center or related..
... Inbound Contact Representative 2 addresses customer needs which may include complex ... it. Escalates unresolved and pending customer grievances. Decisions are typically focused ... Qualifications Minimum 2 years of..
... Grievances & Appeals Representative 3 (Bilingual English/Spanish) San Juan, PR in ... Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent ... High School Diploma or equivalent..
... & Appeals Representative 3 (Fully Bilingual English/Spanish) San Juan, PR in ... Appeals Representative 3 performs advanced administrative/operational/customer support duties that require independent ... School Diploma or equivalent Fully..
Description The Supervisor, Consumer Service Operations is responsible for the ... the daily activities across multiple service functions area. The Supervisor, Consumer ... functions area. The Supervisor, Consumer Service Operations..
Description The Supervisor, Grievances & Appeals manages client medical denials by conducting a comprehensive analytic review of clinical documentation to determine if an appeal is warranted. The Supervisor, Grievances & Appeals ..
... delivers, and manages products for customer use. The Product Manager 2 ... developing products to meet specific customer needs and achieve specific cost ... efficacy of products and uses..
Description The Claims Processing Representative 3 reviews and adjudicates complex or specialty claims, submitted either via paper or electronically. The Claims Processing Representative 3 performs advanced administrative/operational/customer support duties that require ..
... warranted. Perform advanced administrative and/or customer support duties that require independent ... and identify core issues Strong customer focus, analytical and decision making ... remote out of your home..
... Inbound Contacts Representative 2 (Fully Bilingual in English/Spanish) in San Juan ... varied activities and moderately complex administrative/operational/customer support assignments. Performs computations. Typically ... as a member advocate, addressing..
Description The Supervisor, Inbound Contacts represents the company by addressing incoming telephone, digital, or written inquiries. The Supervisor, Inbound Contacts works within thorough, prescribed guidelines and procedures; uses independent judgment requiring ..
... Medicare Members and provide excellent service and support. Currently these roles ... Inbound Contact Representative 2 addresses customer needs which may include complex ... it. Escalates unresolved and pending..
... quality of inbound and/or outbound customer service calls, call documentation, processes and ... or higher Medicare/Medicaid experience Fully Bilingual English/Spanish. Must be able to ... weeks (Practice/Quality) Internal Candidates..
Description The Quality Assurance Technician develops and implements programs to establish and maintain quality standards of existing products and services, as well as developing programs to focus employees on the quality ..
... Research & Resolution Representative 2 (Bilingual - English/Spanish) (Remote) in San ... Juan Puerto Rico Description The Bilingual Claims Research and Resolution Representative ... and Resolution Representative 2 address..
Description The Bilingual Claims Research and Resolution Representative ... and Resolution Representative 2 address customer needs which may include complex ... it. Escalates unresolved and pending customer inquiries How we..
... Humana Call Quality Professional 1 (Bilingual English/Spanish) in San Juan Puerto ... quality of inbound and/or outbound customer service calls, call documentation and processes. ... office (Satellite and Wireless..
Description The Credentialing Assistant 3 obtains and reviews documentation to determine status in a health plan. The Credentialing Assistant 3 performs advanced administrative/operational/customer support duties that require independent initiative and judgment. ..
... Outbound Contact Representative 3 (FULLY Bilingual English/Spanish) San Juan, Puerto Rico ... Contacts Representative 3 performs advanced administrative/operational/customer support duties that require independent ... a timely basis to achieve..
Description The Claims Review Representative 3 makes appropriate claim decision based on strong knowledge of claims procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3 performs advanced ..
... Medicare Members and provide excellent service and support. These roles will ... Inbound Contact Representative 2 addresses customer needs which may include complex ... it. Escalates unresolved and pending..
