Client Experience & Appeals Coordinator

APS Health Care PR; San Juan (PR); On-site; USD 32,000 - 45,000; Full time

Job summary

APS Health Care PR in Puerto Rico seeks a Client Services Coordinator 2 to deliver outstanding service to members, providers, facilities, and staff. You will assess needs and coordinate responses to ensure smooth operations.

This role is dedicated to the Quality Department, requiring strong organization, regulatory awareness, and proficient MS Office skills. Minimum 2 years in customer service and a high school diploma are expected.

Qualifications

• Minimum 2 years of experience in a customer service position.
• Proficient with Microsoft Word, Excel, PowerPoint and Outlook at an intermediate level.
• High School Diploma required.

Responsibilities

• Complies with CMS and regulatory guidelines where applicable.
• Recognizes customer needs to assist in a complaint, grievances, or appeals.
• Receives, prepares, and manages a complaint, grievances, or appeal file.
• Maintains a record of grievances and appeals using various documentation systems.
• Conducts investigations to resolve complaints, grievances, and appeals.
• Maintains database by entering information and sending letters to beneficiaries and facilities when regulations apply.
• Monitors and complies with notification timelines to beneficiaries and facilities.
• Uses clinical data only for non-interpretive activities related to service requests.
• Other duties assigned by the manager or supervisor.

Skills

Customer service

Education

High School Diploma

Tools

Microsoft Word

Excel

PowerPoint

Outlook

Job description

APS Health Care PR in Puerto Rico seeks a Client Services Coordinator 2 to deliver outstanding service to members, providers, facilities, and staff. You will assess needs and coordinate responses to ensure smooth operations.

This role is dedicated to the Quality Department, requiring strong organization, regulatory awareness, and proficient MS Office skills. Minimum 2 years in customer service and a high school diploma are expected.