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Provider Service Executive
Guaynabo, PR
ABOUT US At Grupo Triple S, we are committed to provide meaningful job experiences for Our Valuable People (Nuestra Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results.
When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let’s build healthier communities together, join now!
ABOUT THE ROLE Manages the business relationship with participating providers. Provides a high level of customer service and identifies trends, threads and opportunities within providers. Builds and nurtures strong business relationship with providers. Requires ability to learn and follow policies, procedures and standards of their area, department and other related departments. Performs planning efforts within the department, whether for operational situations from day to day or project assignments or to coordinate multiple resources within the department or division. Anticipates customer needs and acts proactively to ensure their satisfaction. Responsible to influence recommendations or decisions through critical reviews. Maintains a direct relationship with providers through immediate and effective attention of needs presented by them.
WHAT YOU'LL DO
Provide guidance to suppliers through visits where they distribute information on billing, claims processing, established policies and others.
Identify common and repetitive problems and implement corrective action and channel requests for information and/ or claims from providers.
Offer seminars to providers and their staff and some other facilities like Clinical Labs, Chemotherapy facilities on the process of Claims, Billing, Electronic Health System, Coordination of Benefits and company policies.
Orient the providers about the circular letters and the changes that occur.
Communicate the results of provider claims denials before they occur.
Identify and report findings in writing to the supervisor and Vice President of the division through established processes.
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.
Generate reports to providers related to reconciliation process as per their request.
Maintain liaison with other departments for issue completion.
Participate in special projects assigned by supervisor.
Other tasks as assigned by the management are essential.
WHAT YOU'LL BRING Bachelor’s Degree in Business Administration or Health Science; with one (1) to three (3) years of related experience.
Current/Valid Driver License in PR and public liability insurance.
CLOSING DATE:
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug‑free company.
Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Females, Veterans and Disabled to Apply
#J-18808-Ljbffr
Guaynabo, PR
ABOUT US At Grupo Triple S, we are committed to provide meaningful job experiences for Our Valuable People (Nuestra Gente Valiosa). We encourage an environment of very high ethical standards, always excelling in service, collaboration among the company, agility to deliver timely, and embracing accountability for results.
When you join Grupo Triple S, you will be key to our efforts on delivering high-quality and affordable healthcare as well as contribute to our purpose to enable healthier lives. We serve more than 1 million consumers in Puerto Rico through our Medicare Advantage, Medicaid, Commercial, Life and Property & Casualty Businesses.
Let’s build healthier communities together, join now!
ABOUT THE ROLE Manages the business relationship with participating providers. Provides a high level of customer service and identifies trends, threads and opportunities within providers. Builds and nurtures strong business relationship with providers. Requires ability to learn and follow policies, procedures and standards of their area, department and other related departments. Performs planning efforts within the department, whether for operational situations from day to day or project assignments or to coordinate multiple resources within the department or division. Anticipates customer needs and acts proactively to ensure their satisfaction. Responsible to influence recommendations or decisions through critical reviews. Maintains a direct relationship with providers through immediate and effective attention of needs presented by them.
WHAT YOU'LL DO
Provide guidance to suppliers through visits where they distribute information on billing, claims processing, established policies and others.
Identify common and repetitive problems and implement corrective action and channel requests for information and/ or claims from providers.
Offer seminars to providers and their staff and some other facilities like Clinical Labs, Chemotherapy facilities on the process of Claims, Billing, Electronic Health System, Coordination of Benefits and company policies.
Orient the providers about the circular letters and the changes that occur.
Communicate the results of provider claims denials before they occur.
Identify and report findings in writing to the supervisor and Vice President of the division through established processes.
Obtain and examine all relevant information to assess validity of complaints and to determine possible causes.
Generate reports to providers related to reconciliation process as per their request.
Maintain liaison with other departments for issue completion.
Participate in special projects assigned by supervisor.
Other tasks as assigned by the management are essential.
WHAT YOU'LL BRING Bachelor’s Degree in Business Administration or Health Science; with one (1) to three (3) years of related experience.
Current/Valid Driver License in PR and public liability insurance.
CLOSING DATE:
It is company policy to seek for the qualified applicants for positions throughout the company without distinction of race, color, national origin, religion, gender, gender identity, real or perceived sexual orientation, civil status, social condition, political ideologies, age, physical or mental disability, veteran status or any other characteristic protected by law. Drug‑free company.
Equality Employment Opportunity/Affirmative Action for Minorities/Females/People with Disabilities/Veterans. Employer with E-Verify to verify the eligibility of employment of all the new employees.
We encourage Females, Veterans and Disabled to Apply
#J-18808-Ljbffr