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Enrollment RepresentativeGuaynabo, PRQUIENES SOMOS

En Triple S, estamos comprometidos en brindar experiencias laborales significativas para Gente Valiosa.
Fomentamos un ambiente de trabajo de los altos estndares ticos, siempre destacndonos en servicio, colaboracin entre compaeros, agilidad para entregar a tiempo y rendicin de cuentas para lograr resultados.

Al unirte del Grupo Triple S, sers pieza clave para nuestros esfuerzos de brindar atencin mdica accesible y de alta calidad, as como tambin contribuirs a nuestro propsito de habilitar vidas saludables.
En Puerto Rico atendemos a ms de 1 milln de asegurados a travs de nuestras lneas de negocios Medicare Advantage, Medicaid, Comercial, Vida y Propiedad & Contingencia.

Construyamos comunidades saludables juntos.
¡nete a nosotros!

ACERCA DEL ROL

Efecta tareas no rutinarias de manera independiente en apoyo de los procesos de suscripcin y renovacin de servicios de salud aplicando procedimientos y guas operacionales variadas bajo supervisin general.
Puede fungir como adiestrador y conlleva uso de juicio para realizar anlisis y evaluacin de peticiones para determinar y ejecutar la accin adecuada.Completa tareas independientes relacionadas con la membresa, incluyendo datos de proceso, validacin de elegibilidad y cambios.
Asegurar la exactitud de membresa dentro del sistema, transaccin de inscripcin / Medicare y calidad del Medicare, PBM / S y todas las agencias y proveedores externos.
Responsable del mantenimiento de los miembros.

LO QUE ESTARS HACIENDO

  • Analiza y procesa transacciones a nivel de suscripcin del asegurado, tales como adiciones, creacin de contratos, cambios demogrficos y renovaciones de acuerdo con las regulaciones de CMS, ASES y/u otras agencias segn aplique.
  • Aplica reglas de suscripcin y procedimientos establecidos a las peticiones de suscripcin recibidas cumpliendo con las agencias reguladoras aplicables.
  • Revisa las transacciones procesadas para asegurar la precisin de la informacin configurada de acuerdo con las peticiones recibidas.
  • Analiza reportes de error resultantes de los procesos de elegibilidad electrnica y corrige entradas al sistema de acuerdo con lo solicitado por el cliente.
  • Realiza mantenimientos asociados con el proceso de Coordinacin de Beneficios aplicando las reglas establecidas
  • Analiza reportes de error y de ser necesario corrige la activacin de asegurados en los sistemas de los PBMs.
  • Evala y determina la accin a tomar sobre peticiones del cliente, de acuerdo a leyes aplicables.
  • Ocasionalmente digitaliza documentacin relevante aplicada para el trmite de peticiones procesadas.
  • Cumplir con los indicadores establecidos y mtricas MTM.
    Informar a la gerencia de cualquier situacin que pueda afectar el cumplimiento o impacte la ejecucin.
  • Recibir, procesar y analizar y reconciliar los archivos ASES con el fin de identificar al miembro que pierde la elegibilidad de PSG e identificar y corregir discrepancias
  • Documenta toda la informacin y resolucin de problemas en el sistema, asegurando el cumplimiento de los requisitos de las agencias reguladoras y las polticas y procedimientos de la organizacin.
  • Asegrese de que los controles internos se implementen segn lo diseado y se mantenga actualizado y resuelva rpidamente cualquier hallazgo.
LO QUE DEBES TRAER

Grado Asociado en Administracin de Empresas, Mercadeo o Comunicaciones completado o al menos 60 crditos universitarios o colegiales, con un ao de experiencia relacionada al Servicio al Cliente o Reclamaciones dentro de la industria de Seguros de Salud, preferiblemente.O en su lugar, Diploma de Escuela Superior con un mnimo de 3 aos de experiencia en Servicio al Cliente o Reclamaciones dentro de la industria de Seguros de Salud, preferiblemente.

"Es poltica de la compaa buscar a los(las) solicitantes calificados(as) para puestos en toda la empresa sin distincin de raza, color, origen nacional, religin, gnero, identidad de gnero, orientacin sexual real o percibida, estado civil, condicin social, las ideologas polticas, edad, discapacidad fsica o mental, condicin de veterano o cualquier otra caracterstica protegida por la ley".

Empresa libre de drogas.
"Patrono con Igualdad de Oportunidad de Empleo".
Accin Afirmativa para Mujeres, Minoras, 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"

Read the full job description and apply online on the recuiter's web-site

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