unit

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:** 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 Exempt **GENERAL DESCRIPTION:** Provides education to internal and external clients on operational topics that promote efficiency in the process executed by our providers and business partners, such as the Risk Adjustment payment model “CMS-HCC”, ensuring best practices in coding standards and clinical documentation within the medical...

Regular Non-Exempt **GENERAL DESCRIPTION:** The Beneficiary Value Program Efficiency Clerk is responsible for the accurate classification, registration, and monitoring of operational items related to Te Paga within designated electronic portals. The Clerk ensures items are properly categorized, validated, documented, and escalated when issues...

Regular Non-Exempt **GENERAL DESCRIPTION:** Receive the Grievances, Pre-Service Appeals, Post-Service Appeals, Payment Disputes, Payment Appeals, and Administrative Organizational Determinations (AOD) filed by Providers and members, as applicable. Responsible for filling and assigning cases to the Specialists in accordance with established time...

Temporary - AEP Non-Exempt **GENERAL DESCRIPTION:** Manages the orientation, presentation, and medical plan sales process, complying with established policies and procedures in conjunction with the laws and regulations applicable to the industry. Receives calls from prospective clients, identifying their eligibility, and fosters interest to guide...

**Location:** **This position is based in Puerto Rico only.** This field-based role enables associates to primarily operate in the field, traveling to client sites or designated locations as their role requires, with occasional office attendance for meetings or training. This approach ensures flexibility, responsiveness to client needs, and direct, hands-on...

**Job Description** **Role Overview** We are looking for a motivated Applied AI Specialist to join our growing Voice AI team. This role suits candidates who combine a solid grounding in software engineering fundamentals with strong testing discipline and a customer-focused mindset. You will initially own feature testing and quality assurance for our Voice...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for handling, validating, and completing requests and reconciliations related to the Beneficiary Value Program. Assess program reconciliation and collaboration with cross-functional teams to enhance overall program performance to ensure that the Beneficiary Value Program goals align with the...

Regular Exempt **GENERAL DESCRIPTION:** The Health Educator is responsible for designing and implementing educational interventions aimed at preventive care, healthy lifestyles promotion and condition management aligned with the goals and objectives of the company’s Wellness Program. **ESSENTIAL FUNCTIONS:** - Design and develop...

Regular Non-Exempt **GENERAL DESCRIPTION** : The Beneficiary Value Program Efficiency Analyst is responsible for preserving the quality of the product by analyzing and developing operational data and report requests related to Te Paga. Provides administrative and analytical support in the implementation and monitoring of Te Paga-related...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for receiving, registering, and forwarding applications received within the unit to certify the chronic conditions of beneficiaries for a chronic product. Responsible for the confirmation of chronic conditions for the C-SNP plan members. Enters data from health status and risk factor...

**Job Summary** Strategic and operational leader responsible for designing, implementing, and optimizing the clinical excellence shared services unit within Clinical Operations. This role ensures that cross-functional clinical and administrative processes are agile, scalable, data-driven, and aligned with the highest quality standards. The Director will lead...

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...

For Health and Safety support  **WHAT MAKES YOU A FIT: .png)** **The Technical Part:** - Bachelor’s Degree and or an equivalent of five (5) years of exposure in Industrial and Constructions projects within the regulated...

For Health and Safety support  **WHAT MAKES YOU A FIT:** **The Technical Part:** - Bachelor’s Degree and or an equivalent of five (5) years of exposure in Industrial and Constructions projects within the regulated industry. - Bilingual (Spanish and English). - Good organizational and problem solving skills. - Shift: First (Monday-Friday) & according...

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 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...

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...