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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...

Regular Exempt **GENERAL DESCRIPTION:** Supervises and monitors pre-service appeals, payment appeals or disputes, Complaint Tracking Module (CTM) grievances through the Center for Medicaid and Medicare Services (CMS), Administrative Organization Determinations (AOD), grievances, and Late Enrollment Penalty (LEPs) reconsiderations submitted by the...

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...

Regular Exempt **GENERAL DESCRIPTION:** The Coding & Payment Rule Specialist is responsible for identifying coding guidelines established by the American Medical Association's (AMA) standard classification systems (ICD-10, CPT, HCPCS) and payment rules established by the Centers for Medicare & Medicaid Services (CMS) for the proper and timely...

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...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for the operation of the units that manage the Comprehensive Health Risk Assessment (CHRA), retrospective projects, and clinical coding processes. Guarantees compliance with established procedures following operational guidelines and rules established by the different accrediting agencies, such...

## Responsibilities **Senior Commercial Building Inspector (CBI)** *Full-TimeLocation: U.S. Virgin Islands (primarily St. Croix – On-Site / Field-Based)* We are seeking a highly experienced and fully qualified Commercial Building Inspector (CBI) to perform inspections on commercial *(non-residential)* structures across the U.S. Virgin Islands, primarily...

At Lilly, the work is demanding because patients are waiting. We unite caring with discovery to help make life better for people around the world, knowing that every decision, every detail, and every day matters. Headquartered in Indianapolis, Indiana, our over 50,000 employees around the globe take on complex challenges to discover and deliver life-changing...

Posición estratégica centrada en el cliente, al equipo de servicio al cliente será el embajador de Daikin hacia el cliente, asegurar que todos los pedidos se procesen de manera oportuna, supervisar que se cumplan con las políticas de venta de la compañía, confirmar el cumplimiento del backlog. Crear un fuerte vínculo y supervisar las operaciones...

The Condado Collection is a collection of hospitality properties in Puerto Rico ranging from classic and modern luxury full-service hotels, to fine dining and entertainment. La Concha Resort is a modern luxury resort in Condado, Puerto Rico with history dating back to 1958. Epitomizing the fun “Latino Chic” lifestyle, offering stylish...

Company Description Linkup HR is a human resources and talent solutions company focused on helping organizations optimize their workforce and operational performance. The company supports clients across various industries by providing recruitment, staffing, and HR consulting services tailored to their business needs. Linkup HR emphasizes collaboration,...

Date Posted:2026-07-31 Country:United States of America Location:US-PR-REMOTE Position Role Type:Remote U.S. Citizen, U.S. Person, or Immigration Status Requirements:U.S. citizenship is required, as only U.S. citizens are authorized to access certain necessary systems. Security Clearance: None/Not Required The...

Date Posted:2026-08-01 Country:United States of America Location:US-PR-AGUADILLA-110 ~ Rd 110 N Km 28.8 ~ RD110 Position Role Type:Hybrid U.S. Citizen, U.S. Person, or Immigration Status Requirements:U.S. citizenship is required, as only U.S. citizens are authorized to access information under this program/contract. ...

OverviewThe Lemartec Senior Scheduler will assist Project Managers in the planning and scheduling of design & construction projects, preferably in Heavy Industrial construction. Company OverviewFounded in 1979, Lemartec is a national general contractor and construction management firm, part of the General Building group within MasTec’s Clean...

Gerente de Ingeniería y Diseño $50/hr-$60/hr Añasco, Puerto Rico Requisitos y Experiencia Requerida Contar con 10 años de experiencia en entornos de ingeniería y manufactura. Experiencia trabajando de cerca con firmas de Arquitectura e Ingeniería (A&E), paquetes Basis of Design (BOD), revisiones de diseño y documentos de...

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 diversity and...

NOTE: ONLY FOR PUERTO RICO CANDIDATES. We are building the best workplace for thinkers, experts, service agents, designers, and developers to come together to innovate, grow, and truly make an impact in other peoples' lives through technology. We are proud creators of: Expert Tax - tax preparation software for...

OverviewSP+, a Metropolis company, is an artificial intelligence company for the real world. We use computer vision to enable checkout-free parking experiences. So there’s no fumbling with tickets, machines, apps, or credit cards. You just “drive in and drive out.” We are the largest parking network in America, with over 23,000 employees...

Compensation TypeHourly Highgate Hotels Highgate is a premier real estate investment and hospitality management company widely recognized as an innovator in the industry. Highgate is the dominant player in U.S. gateway markets including New York, Boston, Miami, San Francisco and Honolulu, with a rapidly expanding presence in Europe, Latin America,...

The QA Certification role is responsible for ensuring the quality and stability of software releases by executing manual testing activities during sanity, certification, and regression testing cycles. This role collaborates closely with the QA and Development teams to validate application functionality, identify and report defects, maintain test assets,...