Note: The job is a remote job and is open to candidates in USA. Capitol Bridge Puerto Rico is hiring an Onsite Case Reviewer I/Customer Support Representative to provide customer support and review Workers’ Compensation Medicare Set-Aside proposals and medical records for CMS threshold requirements. The role also handles customer inquiries and administrative case documentation.
Responsibilities
- Respond to customer inquiries and concerns via phone, email, and chat
- Provide courteous and professional assistance to resolve caller issues
- Ensure a high level of customer satisfaction through effective communication
- Review and assess cases, ensuring accuracy and adherence to established CMS guidelines
- Ensure all basic documentation requirements are available or requested via development action prior to making a determination
- Maintain organized and up-to-date records of customer interactions and case reviews
- Other duties as assigned by management
- Collaborate with the team to identify areas for process improvement
- Contribute to a positive and collaborative team environment
Skills
- High School Diploma or GED
- 1+ years of customer service experience (call center or inbound phone support)
- Strong medical literacy with the ability to navigate, review, and evaluate complex medical documents
- High attention to detail with strong analytical skills to verify documentation against specific threshold requirements
- Proficiency with standard office software (Microsoft Office Suite: Word, Excel, Outlook) and comfortable learning case management software/databases
- Fast and accurate data entry skills for maintaining customer records and case review notes
- Excellent verbal and written communication skills with a professional, empathetic telephone demeanor
- Active listening skills to understand customer needs, resolve inquiries efficiently, and de-escalate calls when necessary
- Strong team player with a collaborative attitude and a willingness to share process improvement ideas
- Strong organizational and time-management skills, with the ability to prioritize daily task loads between live calls and desk reviews
- Ability to follow complex, standardized regulatory guidelines strictly and consistently
- High degree of discretion when handling confidential patient and claim information
- Associate degree or coursework in Healthcare Administration, Paralegal Studies, or a related field
- Prior experience handling medical records, insurance claims, or legal documentation
- Basic understanding of Workers' Compensation, Medicare Set-Aside (MSA) proposals, or CMS guidelines
Benefits
- Paid Training
- Paid Holidays
- Retirement benefits 401K (1st day of the month after 6 months of employment)
- Life Insurance (100% employer contribution)
- Vacation Leave and Sick Leave dictated by PR Labor Law
- Health & Welfare (H&W) contribution of $4.93 for every hour paid (including PTO, but excluding overtime hours), up to 40 hours per week or as defined by the applicable wage determination; utilized to pay for benefit coverage
Company Overview