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**About AbbVie** AbbVie's mission is to discover and deliver innovative medicines and solutions that solve serious health issues today and address the medical challenges of tomorrow. We strive to have a remarkable impact on people's lives across several key therapeutic areas including immunology, oncology and neuroscience - and products and services in our...

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...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for coordinating, routing, and following up on operational requests related to the department and/or unit. Provides administrative support, manages documentation, and ensures compliance with internal processes and regulatory requirements, contributing to operational efficiency and service...

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:** 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)...

Regular Non-Exempt **GENERAL DESCRIPTION:** Provides first-level technical support to internal and external customers by responding to service requests, answering inquiries, resolving or escalating technology-related issues, and ensuring timely follow-up. Troubleshoots hardware, software, and system problems, documents incidents and requests, and...

**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 Exempt **GENERAL DESCRIPTION:** Carries out nursing functions in performing care management process, organizational determinations, and transitional care, including, but not limited to, health assessments, biopsychosocial needs assessment, and barriers for policyholders with medical conditions to develop a comprehensive and customized...

**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...

We are seeking an experienced and results-driven Estimating **Manager** to lead and optimize our Estimating Department. This key leadership role is responsible for overseeing all estimating activities, ensuring accuracy, consistency, efficiency, and on-time delivery of proposals aligned with the company's strategic goals. The ideal candidate will bring...

Feeling stuck? Put your career in motion with a great, new opportunity. Join the Kelly® team as a Strategic Services Coordinator to work at a leading organization in San Juan, PR. We’re here every step of the way to help you and your career be the best it can be. Bring your energy and expertise. We’ll help you get where you want to be. Salary/Pay...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for directing, developing initiatives, and establishing plans of action to ensure compliance with service standards, comply with the needs of internal and external clients, and achieve the renewal goals established by the company. Responsible for the service and renewals of the groups under...

Regular Exempt **GENERAL DESCRIPTION:** Evaluates the handling, processing, and/or payment of medical and/or life insurance claims to seek efficiency in the claim adjudication processes of each of the analysts, according to the parameters established in the unit, and seeks continuous improvement and compliance with corporate results. Makes...

🔍 **Title:** Senior Computer System Validation Specialist **📍Location:** East Puerto Rico | Work Setting: Onsite | Availability: Immediate **Position Overview** **Our client is seeking a Senior Computer System Validation (CSV) Specialist with strong C&Q, CQV, Engineering, Validation, and compliance SME expertise to support Drug Product...

Detalle de la Convocatoria ❮ Regresar al listado❮ Regresar al listado Título del Puesto Auxiliar de Manejo de Casos Entidad o Municipio Municipio de Carolina **Región** Carolina Región / Municipio No items found.  Convocatoria parte del Plan Piloto Número de la Convocatoria ...

The BSA Monitoring Analyst evaluates sensitive information concerning customer account activity including transactional data to prevent and assess if such activity may be potentially linked to unlawful practices related to money laundering, terrorist financing, organized crime, and other financial crime activity in order in order to determine if a subsequent...

Regular Exempt **GENERAL DESCRIPTION:** Represents the company in official service negotiations with assigned group. Attend, channel, and solve the different situations from customers, underwriters, and producers as required. Responsible for coordinating and negotiating with the underwriting department the renewal proposal of groups assigned to...

**Job Overview** This position gives complete support to HMS program, Kaizen events, continuous improvements in manufacturing & supporting areas. Train associates on PSQDC and Kaizen methodology, as well as the HMS Methodology. Work closely with CI Manager generating & executing follow-up reports on sustainment status. Perform audits for HMS elements to...

At Triple-S, we are committed to providing meaningful job experiences for Valuable People (Gente Valiosa). We strive for excellence in everything we do, from the way we work together to the way we serve our customers. When you join Triple-S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our...

**Incident Problem Mgmt. Sr. Specialist** Responsible for managing the process designed to identify recurrence, severity, and impact of incidents, and to associate common causes with the specific purpose of implementing operational or programming measures that prevent or reduce recurring or critical events. **ESSENTIAL DUTIES AND...