Medical & Life Claims Adjudication Specialist

MCS Puerto Rico; San Juan (PR); On-site; USD 42,000 - 65,000; Full time

Job summary

MCS Puerto Rico is hiring for a claims analyst position focused on evaluating and processing medical and life insurance claims to optimize adjudication efficiency and ensure compliance with corporate results. The role involves analyzing complex claims, ensuring adherence to standards, and consulting with other departments as needed.

The ideal candidate has a Bachelor's or Associate's degree with 2+ years in the industry, strong analytical skills, and proficiency in Excel, Word, Access, and

Qualifications

• Bachelor's Degree or Associate's Degree with industry experience required.
• At least 2 years in the industry with analytical and statistical knowledge and claims processing.
• Familiarity with quality parameters and industry standards.

Responsibilities

• Evaluate handling, processing, and/or payment of medical and/or life insurance claims at adjudication.
• Verify adherence to standards and regulatory guidelines during claim adjudication.
• Analyze complex COB, reimbursement, adjustments, and recoveries within policy parameters.
• Review CMS policies and other regulatory guidelines; monitor compliance.

Skills

Analytical skills

Statistical knowledge

Claims processing

Quality parameters

Education

Bachelor's Degree

Associate's Degree or 60–64 credits

Tools

Excel

Word

Access

PowerPoint

Job description

MCS Puerto Rico is hiring for a claims analyst position focused on evaluating and processing medical and life insurance claims to optimize adjudication efficiency and ensure compliance with corporate results. The role involves analyzing complex claims, ensuring adherence to standards, and consulting with other departments as needed.

The ideal candidate has a Bachelor's or Associate's degree with 2+ years in the industry, strong analytical skills, and proficiency in Excel, Word, Access, and