Remote Claims Intake & Case Coordination Specialist

Capitol Bridge, Llc; Puerto Rico; Hybrid; USD 23,000 - 32,000; Full time

Job summary

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

The position requires a high school diploma and 2+ years in administrative or healthcare-related roles, with strong communication in English and proficiency in Outlook,

Qualifications

• High school diploma or equivalent.
• Two or more years of administrative, healthcare, claims, insurance, medical office, case support, or comparable experience.
• Strong attention to detail and ability to manage multiple cases and deadlines simultaneously.
• Proficiency with Microsoft Outlook, Word, Excel, PDFs, and electronic document repositories.
• Strong written and verbal communication skills in English.

Responsibilities

• Receive, log, organize, and perform administrative intake of incoming claim dispute cases and supporting documentation.
• Review case files for administrative completeness and identify missing, unreadable, or inconsistent documentation for follow-up.
• Maintain accurate case status, correspondence, dates, assignments, and documentation in program systems and trackers.
• Prepare and organize case packets for RN reviewers, coding specialists, physicians, attorneys, and other credentialed reviewers.
• Route cases and documentation according to established workflows and escalation procedures.
• Monitor case aging, due dates, and required turnaround times; escalate cases at risk of delay.
• Conduct administrative outreach to providers, health plans, enrollees, or other parties using approved procedures and templates.
• Prepare standard notices, correspondence, and determination packages for review and distribution.
• Support case reconciliation, reporting, audit requests, and Quality Assurance/Quality Control activities.
• Protect confidential information and comply with applicable privacy, security, project, and company requirements.
• Participate in required meetings, training, process updates, and implementation of regulatory or client-directed changes.

Skills

Administrative support

Healthcare claims

Microsoft Office

English communication

Attention to detail

Education

High school diploma

Tools

SharePoint

ShareFile

Case management systems

Job description

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

The position requires a high school diploma and 2+ years in administrative or healthcare-related roles, with strong communication in English and proficiency in Outlook,