Oficinista de Reclamaciones

Oficinista de Reclamaciones Location San Juan, PR (Hato Rey Central area) :

Oficinista de Reclamaciones

Regular

Non-Exempt

GENERAL DESCRIPTION:

Office work involves receipt, classification, and digitization of the claims received and other related documents. Prepares inventory reports by the type of claims received.

ESSENTIAL FUNCTIONS:

• Receives and punches out with the date of receipt of the claims received at the counter and receives the correspondence from UPS and ACT.
• Draws and classifies administrative correspondence and claims working by date of receipt.
• Verifies non-processable or incomplete claims and returns to providers/policyholders.
• Deposits the mail in the mailboxes in the Mailing Unit to deliver them to the Administration messenger for them to be distributed to the different departments. Delivers the correspondence to the departments that require an acknowledgment of receipt.
• Prepares claims for their digitization.
• Carries out a quality process for claims for digitization, packaging of the "batches" of claims, and post-digitization.
• Processes no less than the average number of claims per hour established by MCS (which may vary from time to time).
• Performs the document scanning process.
• Complies with and updates their personal productivity report daily.
• Imports and exports claim data as required.
• Prepares letters, labels, and envelopes for the claims to be returned to the provider or member.
• Receives and validates the classification of claims, and accounts, and coordinates the claims received from providers and members that have already been digitized.
• Classifies adjustments, complaints, and special cases.
• Archives claims according to the parameters established for this process.
• Prepares inventory reports by the type of claims received.
• Performs the pre-process adjustments to determine whether the claims are actionable or not.
• Prepares provider audit reports in Excel, as well as other required reports.
• Makes a physical inventory of archived claims.
• Records and forwards claim to other support departments.
• Registers and verifies through the "Referral Claims" program.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and experience: High School Diploma or Technical Course. At least 6 months of experience performing tasks in a similar position.

"Proven experience may be replaced by previously established requirements."

Certifications / Licenses: N/A

Other: N/A

Languages: Spanish - Basic (writing, conversational, and comprehension) English - Basic (writing, conversational, and comprehension)

“Somos un patrono con igualdad de oportunidad en el empleo y tomamos Acción Afirmativa para reclutar a Mujeres, Minorías, Veteranos Protegidos y Personas con Impedimento ”