Case Reviewer I/Customer Support Representative

Capitol-Bridge; Sector Toledo (PR); On-site; USD 25,000 - 34,000; Full time

Benefits offered by this job

Paid training

Paid holidays

401K (after 6 months)

Life Insurance (employer contribution)

Vacation & Sick Leave

Employee Assistance Program

Job summary

Capitol Bridge Puerto Rico is seeking an Onsite Case Reviewer I/Customer Support Representative in Isabela, Puerto Rico. The role combines customer support with case review of WCMSA proposals, ensuring CMS threshold compliance and accurate documentation.

The position requires 1+ year of customer service, familiarity with medical records, and strong attention to detail. On-site work with comprehensive health, retirement, and EAP benefits is provided.

Qualifications

• 1+ years of customer service experience required.
• Experience with medical records, insurance claims, or legal documents preferred.
• Basic understanding of Workers' Compensation or CMS guidelines a plus.
• Strong attention to detail and data entry skills.
• Familiarity with case management software is a plus.

Responsibilities

• Respond to customer inquiries via phone, email, and chat.
• Review and assess cases following CMS guidelines.
• Maintain organized records of interactions and case reviews.
• Collaborate with team to identify process improvements.
• Provide professional and empathetic customer support.

Skills

Customer service

Medical records

CMS guidelines

Data entry

Office software

Education

High School Diploma or GED

Associate degree preferred

Tools

Microsoft Office

Case management software

Job description

Job OverviewCapitol Bridge Puerto Rico is currently seeking an Onsite Case Reviewer I/Customer Support Representative to join our team in Isabela, Puerto Rico.As a CSR/CR1, you will play a pivotal role in ensuring exceptional customer support and efficient administrative case review. You will review Workers Compensation Medicare Set-Aside (WCMSA) proposals, including medical records, to determine if the proposal meets CMS threshold requirements. In this position, you will also be responsible for answering phone calls, addressing customer inquiries, and performing basic administrative duties.Location: On-Site –Isabela, Puerto RicoPay and Benefits:Compensation: $17.75 per hour plus $4.93 H&WPaid TrainingPaid HolidaysRetirement benefits 401K (1st day of the month after 6 months of employment)Life Insurance (100% employer contribution)Vacation Leave and Sick Leave dictated by PR Labor Law.Employee Assistance ProgramHealth & Welfare (H&W) dollars - also referred to as fringe dollars - are contributed by your employer to help pay for your benefit coverage as required by the Service Contract Act obligation. There is an H&W contribution for every hour you are paid (including PTO, but excluding overtime hours) up to 40 hours per week or as defined by the applicable wage determination. This H&W contribution is utilized to pay for benefits.Responsibilities:Customer SupportRespond to customer inquiries and concerns via phone, email, and chat.Provide courteous and professional assistance to resolve caller issues.Ensure a high level of customer satisfaction through effective communication.Case ReviewReview and assess cases, ensuring accuracy and adherence to established CMS guidelines.Ensure all basic documentation requirements are available or requested via development action prior to making a determination.Administrative DutiesMaintain organized and up-to-date records of customer interactions and case reviews.Other duties as assigned by management.Team CollaborationCollaborate with the team to identify areas for process improvement.Contribute to a positive and collaborative team environment.Job RequirementsEducation & ExperienceHigh School Diploma or GED required; Associate degree or coursework in Healthcare Administration, Paralegal Studies, or a related field preferred.1+ years of customer service experience (call center or inbound phone support) required.Prior experience handling medical records, insurance claims, or legal documentation is strongly preferred.Basic understanding of Workers' Compensation, Medicare Set-Aside (MSA) proposals, or CMS guidelines is a plus.Technical & Operational SkillsStrong medical literacy with the ability to navigate, review, and evaluate complex medical documents.High attention to detail with strong analytical skills to verify documentation against specific threshold requirements.Proficiency with standard office software (Microsoft Office Suite: Word, Excel, Outlook) and comfortable learning case management software/databases.Fast and accurate data entry skills for maintaining customer records and case review notes.Communication & Interpersonal SkillsExcellent verbal and written communication skills with a professional, empathetic telephone demeanor.Active listening skills to understand customer needs, resolve inquiries efficiently, and de-escalate calls when necessary.Strong team player with a collaborative attitude and a willingness to share process improvement ideas.Work Style & AdaptabilityStrong organizational and time-management skills, with the ability to prioritize daily task loads between live calls and desk reviews.Ability to follow complex, standardized regulatory guidelines strictly and consistently.High degree of discretion when handling confidential patient and claim information.Reasonable AccommodationIf you require alternative methods of application or screening, please contact us directly. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.EEO StatementCapitol Bridge Puerto Rico is an Equal Opportunity Employer. All employment decisions at CBHS are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.Texting NoticeWe communicate with applicants via text in addition to email and phone. If you apply for this position, we may text you regarding your application or other relevant updates. You may opt out at any time.