coordinadora call center

Regular Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – CC is responsible for providing excellent service when answering requests from policyholders, members, and providers through phone calls received. Solves situations or service needs, channeling them through the established operational processes and service...

Optum is a global organization that delivers care, aided by technology to help millions of people live healthier lives. The work you do with our team will directly improve health outcomes by connecting people with the care, pharmacy benefits, data and resources they need to feel their best. Here, you will find a culture guided by inclusion, talented peers,...

Call center Representative Location: Aguadilla PR **Job Description** This position is responsible for providing exceptional customer service while maximizing productivity within our call center in such a manner that supports the mission, values and standards of the Company and focused on client satisfaction. Primary responsibilities include direct...

Regular Non-Exempt **GENERAL DESCRIPTION:** Calls medical offices to request, receive by fax, and register documents contained in the medical records of Classicare policyholders, as required and according to the different initiatives worked on in the unit. Refers documents received by the medical offices to the Risk Assessment unit, to complete...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established operational...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established operational...

Regular Non-Exempt **GENERAL DESCRIPTION:** Analyzes, processes, and adjudicates all types of complex claims submitted in Centers for Medicare and Medicaid Services Form 1500 (CMS‑1500) and Uniform Billing Form 04 (UB‑04) formats, applying the highest level of analytical judgment to determine appropriate payment or denial. This includes the...

**Job Overview** PenFed is hiring a (Onsite) Associate Engineer IT to work onsite at our San Patricio Office Center located in Guaynabo, Puerto Rico. The primary purpose of this job is to provide basic technical and functional support, maintenance, administration, documentation, and integration development using MuleSoft under direct supervision for PenFed's...

**Company Mission** Duo Health is a new type of medical group designed around the needs of patients living with chronic kidney disease. Our proprietary Health Mobilization™ platform partners multidisciplinary care teams with community nephrologists and activates the clinicians, facilities, and community organizations needed to care for the whole patient. ...

Regular Non-Exempt **GENERAL DESCRIPTION:** Supports daily unit operations by completing document intake, evaluation, classification, and distribution processes. Provides guidance to technicians, resolves escalated issues, and acts as a liaison between internal and external teams to ensure efficient workflow and service delivery. Monitors...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for receiving, registering, and forwarding requests for organizational determination and/or any associated clinical documentation or documentation for the clinical management of the insured. Works with the authorizations of services already predetermined through the automatic process using...

**About Scene Health** Scene’s 360° model of care enhances the gold standard of medication adherence, Directly Observed Therapy. Combining personalized video coaching, education, and motivational content, we bring healthcare professionals, patients, and their families together to solve the $500B medication non-adherence problem. Our mobile app allows...

**GENERAL DESCRIPTION:** Responsible for answering and making telephone calls to participating and non-participating providers offering services in the service area and outside the plan service area, as well as to policyholders. Guarantees that situations or service needs are solved at the time of the call and, if necessary, refer to their supervisor any...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for providing guidance and orientation to individuals or members of Medicare and MCS Life products. This includes conducting satisfaction surveys and regulated calls while ensuring compliance with quality, experience, and service standards set by the company and the Centers for Medicare and...

Regular Non-Exempt **GENERAL DESCRIPTION:** Analyzes claims and/or adjustments submitted in Centers for Medicare and Medicaid Services Form 1500 (CMS‑1500) and Uniform Billing Form 04 (UB‑04) formats, as well as member reimbursements, by applying payment rules to determine appropriate adjudication, denial, or the need for additional...

"All of my students came back in the top 1% for growth and achievement on their MAP scores." — Sam DePalo, Lead Guide, Alpha Fort Worth Texas Alpha is hiring. - On-site at Alpha School's Dorado, Puerto Rico campus - $100,000/year ($50/hour, 40 hours/week), paid weekly - No formal teaching certification required; Spanish fluency...

"All of my students came back in the top 1% for growth and achievement on their MAP scores." — Sam DePalo, Lead Guide, Alpha Fort Worth Texas Alpha is hiring. - On-site at Alpha School's Dorado, Puerto Rico campus - $100,000/year ($50/hour, 40 hours/week), paid weekly - No formal teaching certification required; Spanish fluency...

As a **Customer Service Representative (CSR** ), you’ll support business customer accounts by handling a high volume of customer walk-ins, inbound calls, emails, and order inquiries. You’ll work closely with a team of peers to resolve order, product, pricing, billing, and delivery issues quickly and accurately. This role acts as a key customer...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for conducting pharmacy audit, monitoring, and compliance activities to ensure adherence to the Center of Medicare and Medicaid Services (CMS) regulations, contractual requirements, and organizational standards across all Lines of Business (LOBs). Oversee Pharmacy Benefit Management (PBM)...