Claims Review & Case Management Specialist

Capitol Bridge PR, LLC; United States; In loco; USD 23.000 - 32.000; Tempo pieno

Descrizione del lavoro

Capitol Bridge Puerto Rico is seeking a detail-oriented Claims Review Administrative Specialist to support the Florida CDR and multi-state IRO programs. This non-clinical role handles intake, document control, and case progression so reviewers can focus on substantive work.

Payrate: $20/hr. Two+ years' administrative or healthcare experience is preferred. Proficiency with Outlook, Word, Excel, PDFs, and document repositories is required; bilingual English/Spanish is a plus.

Competenze

• High school diploma or equivalent required.
• 2+ years administrative, healthcare, claims, insurance, or related experience.
• Strong attention to detail with multiple cases and deadlines.
• Proficiency with Outlook, Word, Excel, PDFs, and document repositories.
• Excellent written and verbal English communication.
• Ability to handle confidential healthcare information appropriately.

Mansioni

• Receive, log, organize, and intake incoming claim dispute cases and docs.
• Check administrative completeness and flag missing or inconsistent items.
• Maintain accurate case status, dates, and documentation in trackers.
• Prepare case packets for reviewers and other stakeholders.
• Route cases per workflows and escalation procedures.
• Monitor aging, due dates, and turnaround times; escalate delays.
• Conduct outreach to providers, plans, enrollees per approved templates.
• Prepare notices, correspondence, and determination packages.
• Support reconciliation, audits, and QA/QC activities.
• Protect confidential information and comply with privacy rules.

Conoscenze

Attention to detail

Multitasking under deadlines

English communication

Formazione

High school diploma or equivalent

Strumenti

Microsoft Outlook

Microsoft Word

Microsoft Excel

PDFs

SharePoint

ShareFile

Case management systems

Descrizione del lavoro

Capitol Bridge Puerto Rico is seeking a detail-oriented Claims Review Administrative Specialist to support the Florida CDR and multi-state IRO programs. This non-clinical role handles intake, document control, and case progression so reviewers can focus on substantive work.

Payrate: $20/hr. Two+ years' administrative or healthcare experience is preferred. Proficiency with Outlook, Word, Excel, PDFs, and document repositories is required; bilingual English/Spanish is a plus.