Top 1227 Service associate Jobs in Puerto Rico

Claims Examiner Grievance & Appeals
Firstsource Transaction Services, LLC —Guaynabo, PR
- $16 - $18 an hour
- Full-time
- Hybrid work
- Background check
- Microsoft Excel
- Microsoft Outlook
Quick Apply
1d
Remote Bilingual Customer Service Representative
Conduent Business Solutions of Puerto Rico, Inc. —Guaynabo, PR
- $13.67 an hour
- Email
- Remote
- Background check
- Spanish
- English
- Paid training
- Paid holidays
13d
Bilingual Customer Service and Data Entry Specialist
TBI Outsourcing Puerto Rico, Inc. —Guaynabo, PR
- Urgently hiring
- Bilingual
- Background check
- 18 years or older
- Paid training
- Health insurance
Call Center & Contact Center Professionals
Hire Resolve.com —Puerto Rico
- $75,000 - $155,000 a year
- Full-time
- Remote
- 5 years
- High school diploma or GED
- Senior level
- AD&D insurance
- Disability insurance
Quick Apply
Retail Warehouse Associate
Best Buy —San Juan, PR
- $15 - $18 an hour
- Part-time
- Merchandising
- Warehouse
- Warehouse experience
- Paid time off
- Employee discount
5d
Technician I, Remote Care
Abbott Laboratories —Arecibo, PR
- $13.18 - $25.02 an hour
- Overtime
- Remote
- Spanish
- English
- High school diploma or GED
5d
Retail Clerk
Marriott International, Inc —Dorado, PR
- $15.55 an hour
- Full-time
- Merchandising
- High school diploma or GED
- Cleaning
- Free parking
- Health insurance
5d
Bilingual Non-Clinical Care Coach
Humana —Puerto Rico
- $43,000 - $58,100 a year
- Full-time
- Remote
- Spanish
- HIPAA
- English
- Paid parental leave
- Paid holidays
6d
Operations Associate - Part Time
Sephora —Bayamón, PR
- $16.60 - $19.30 an hour
- Part-time
- Sales
- Merchandising
- Ability to lift 50 pounds
- Health insurance
HRIS Time Administrator - REMOTE
Ryder System —San Juan, PR
- Full-time
- Remote
- Microsoft Outlook
- Data analysis skills
- Mid-level
- Disability insurance
- Health insurance
Docucare Associate
Xerox —San Juan, PR
- $30,000 - $60,000 a year
- Full-time
- Customer service
- Computer literacy
- Mid-level
- Health savings account
- Paid holidays
Retail Sales Associate
Best Buy —San Juan, PR
- $15 - $18 an hour
- Part-time
- Cleaning
- Entry level
- Under 1 year
- Paid time off
- Employee discount
5d
USAREC MEPS Recruiting General Clerk III
Summit Technologies, Inc —Guaynabo, PR
- Full-time
- Microsoft Outlook
- Customer service
- English
Quick Apply
Patient Service Associate
Alivia Health —Guaynabo, PR
Quick Apply
13d
Family Support Specialist II
URBAN STRATEGIES INC —San Juan, PR
- $35,000 - $36,000 a year
- Weekends as needed
- Microsoft Outlook
- Computer literacy
- Mid-level
Retail Associate
Ross Stores —Carolina, PR
- Ability to lift 25 pounds
Associate, Retail Channels (Call Center Quality)
Oriental Bank in San Juan —San Juan, PR
- Full-time
- Hybrid work
- Spanish
- Microsoft Excel
- Microsoft Outlook
Customer Service Associate
Walgreens —San Juan, PR
- $15.00 - $17.50 an hour
- Weekends as needed
- Maintenance
- English
- Cleaning
- Health insurance
- Dental insurance
5d
Associate Customer Service
Abbott Laboratories —Arecibo, PR
- $12.80 - $22.40 an hour
- Full-time
- English
- Office
- High school diploma or GED
- Disability insurance
- Health insurance
6d
Pool & Beach Food Runner
Marriott International, Inc —Dorado, PR
- $15.57 an hour
- Full-time
- Hotel
- High school diploma or GED
- Guest services
- Free parking
- Health insurance
8d

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service associate jobs near puerto rico

Claims Examiner Grievance & Appeals

Firstsource Transaction Services, LLC -
Guaynabo, PR

Quick Apply

Job Details

Full-time
$16 - $18 an hour
1 day ago

Qualifications

Healthcare dispute resolution
Appeals
Teamwork
Microsoft Excel
Medical billing and coding data entry
Microsoft Outlook
Workflow management (operations management method)
Insurance dispute resolution
Medical claims processing software
Administrative experience
High school diploma or GED
Medical insurance appeals management
Health information management
Insurance claims appeal handling
Medical terminology

Full Job Description

Job Description: Claims & Appeals & Grievances (A&G) Specialist – Back Office Operations

Job Title: Claims & Appeals & Grievances (A&G) Specialist
Department: Healthcare Operations
Location: United States (Remote)
Employment Type: Full-Time
Experience Required: Minimum 2 years in US Healthcare Back Office Operations

Position Overview

We are seeking a highly organized and detail-oriented Claims & Appeals & Grievances (A&G) Specialist to join our Healthcare Operations team. The ideal candidate will have a minimum of two years of experience supporting US healthcare back-office operations with expertise in claims processing, appeals, grievances, and administrative support functions.

This role is responsible for reviewing and processing healthcare claims, researching and resolving claim-related issues, coordinating appeals and grievance activities, ensuring compliance with regulatory requirements, and maintaining accurate documentation. The successful candidate will demonstrate strong analytical skills, attention to detail, and the ability to work efficiently in a fast-paced, quality-driven environment.

Key Responsibilities

Claims Operations

Review, validate, and process medical, behavioral health, and pharmacy claims in accordance with health plan policies and established business rules.
Perform claim research to identify discrepancies, missing information, eligibility concerns, authorization requirements, and benefit coverage issues.
Verify member eligibility, provider information, coding accuracy, and supporting documentation prior to claim adjudication or escalation.
Analyze suspended, pending, denied, or rejected claims and determine appropriate next steps.
Ensure claims are processed accurately within established turnaround times and service level agreements (SLAs).
Document all actions, findings, and resolutions within the claims management system.

Appeals & Grievances

Receive, review, and process member and provider appeals and grievances in accordance with CMS, state, federal, and organizational requirements.
Research claim history, medical records, benefit plans, provider contracts, and supporting documentation to determine appropriate case resolution.
Coordinate with internal clinical, compliance, provider services, customer service, and operations teams to obtain additional information when required.
Prepare case summaries, correspondence, and resolution documentation while ensuring completeness and accuracy.
Track appeal and grievance cases from receipt through final resolution while meeting regulatory turnaround time requirements.
Escalate complex or high-risk cases to appropriate departments as necessary.

Back Office Operations

Perform data entry, record maintenance, document indexing, and quality validation activities.
Maintain confidentiality of Protected Health Information (PHI) in accordance with HIPAA regulations.
Review operational reports and work queues to prioritize daily workload.
Identify processing errors, trends, or recurring issues and recommend corrective actions.
Participate in quality audits, process reviews, and continuous improvement initiatives.
Support cross-functional operational projects and departmental objectives.

Compliance & Quality

Adhere to CMS, HIPAA, NCQA, and internal compliance standards.
Ensure all documentation is complete, accurate, and audit-ready.
Meet departmental productivity, quality, accuracy, and turnaround time metrics.
Participate in required compliance, privacy, and operational training programs.
Maintain current knowledge of healthcare regulations, benefit plans, and organizational policies.

Required Qualifications

High School Diploma or GED required; Associate's or Bachelor's degree preferred.
Minimum of 2 years of experience in US Healthcare Back Office Operations.
Experience in healthcare claims processing and Appeals & Grievances.
Knowledge of commercial, Medicare, and/or Medicaid health plans.
Understanding of medical terminology, healthcare benefits, and claim workflows.
Familiarity with CPT, ICD-10-CM, HCPCS, and healthcare documentation.
Experience working with claims processing systems, workflow management tools, and electronic document management systems.
Proficiency with Microsoft Office, including Excel, Word, and Outlook.
Strong written and verbal communication skills.
Excellent analytical, organizational, and problem-solving abilities.

Preferred Qualifications

Experience in Managed Care, Health Insurance, Third-Party Administration (TPA), or Healthcare Business Process Outsourcing (BPO).
Knowledge of healthcare regulations governing appeals and grievance processes.
Experience handling high-volume production environments.
Familiarity with quality assurance processes and operational audits.

Core Competencies

Claims Processing
Appeals & Grievance Administration
Claims Investigation
Healthcare Documentation Review
Data Validation & Quality Assurance
Regulatory Compliance
HIPAA Compliance
Medicare & Medicaid Guidelines
Medical Terminology
Attention to Detail
Critical Thinking
Time Management
Customer Focus
Team Collaboration
Problem Solving

Performance Expectations

Achieve established productivity and quality targets.
Meet appeal and grievance turnaround time requirements.
Maintain high claims processing accuracy.
Ensure timely completion of assigned work queues.
Demonstrate compliance with HIPAA, CMS, and organizational policies.
Contribute to continuous process improvement initiatives.
Maintain positive collaboration with internal stakeholders and support teams.

Pay: $16.00 - $18.00 per hour

Work Location: Hybrid remote in Guaynabo, PR 00965

Quick Apply

Refine Your Search

service associate jobs in puerto rico

Claims Examiner Grievance & Appeals

Remote Bilingual Customer Service Representative

Bilingual Customer Service and Data Entry Specialist

Call Center & Contact Center Professionals

Retail Warehouse Associate

Technician I, Remote Care

Retail Clerk

Bilingual Non-Clinical Care Coach

Operations Associate - Part Time

HRIS Time Administrator - REMOTE

Docucare Associate

Retail Sales Associate

USAREC MEPS Recruiting General Clerk III

Patient Service Associate

Family Support Specialist II

Retail Associate

Associate, Retail Channels (Call Center Quality)

Customer Service Associate

Associate Customer Service

Pool & Beach Food Runner

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