BILINGUAL CLAIMS REPRESENTATIVE (HYBRID) in Guaynabo at TPIS

Job Posting Title

BILINGUAL CLAIMS REPRESENTATIVE (HYBRID)

Job Description

Our client in the healthcare industry is seeking Bilingual Claims Representatives to join its Claims and Appeals Operations team. This position supports the review, classification, documentation, and routing of healthcare-related requests, including appeals, member information, provider records, and supporting documentation.

The selected candidates will review incoming cases, validate information, identify appropriate clinical or administrative workflows, and accurately document case details using internal systems and tracking tools. This role is essential to ensuring healthcare requests are processed efficiently, accurately, and within established operational timeframes.

This opportunity is ideal for candidates with experience in Healthcare Customer Service, Call Center Operations, Claims Processing, or High-Volume Administrative Environments who are detail-oriented, comfortable navigating multiple computer systems, and interested in developing their careers within the healthcare industry.

• Review incoming appeals, forms, correspondence, and supporting documentation to identify the nature of each request.

• Determine whether incoming cases should follow clinical or administrative workflows according to established guidelines.

• Research available documentation and internal systems to gather information necessary for accurate case classification.

• Enter, update, and maintain case information in designated tracking systems, databases, and spreadsheets.

• Identify cases requiring clinical review and ensure proper routing to the appropriate teams.

• Review member, provider, and appeal documentation for completeness, accuracy, and consistency.

• Follow established procedures, operational guidelines, business rules, and work instructions.

• Maintain accurate and complete documentation of all work performed.

• Meet established productivity, quality, accuracy, and turnaround-time expectations.

• Identify and escalate incomplete, unclear, or non-standard cases to the appropriate team members or supervisors.

• Organize and prioritize assigned workloads according to established deadlines and operational requirements.

• Collaborate with internal teams, including Case Setup and Appeals Operations, to support timely case processing.

• Adapt to changes in workflows, systems, assignments, and business requirements.

• Perform other duties as assigned.

• Minimum of one (1) year of experience in a Healthcare Call Center or similar high-volume production environment.

• Customer service experience in a fast-paced work environment.

• Fully bilingual in English and Spanish, with professional verbal and written communication skills.

• Proficiency in Microsoft Office, particularly Word and Excel, or comparable Google Workspace applications.

• Strong computer navigation, data entry, and documentation management skills.

• Ability to review, organize, and process detailed information accurately.

• Strong attention to detail, organizational skills, and time-management abilities.

• Ability to follow established procedures, guidelines, and operational requirements.

• Ability to manage multiple assignments while maintaining accuracy and productivity.

• Strong communication, problem-solving, and teamwork skills.

• Ability to adapt to changing priorities and work efficiently in a structured, fast-paced environment.

Candidates with experience in any of the following areas are encouraged to apply:

• Healthcare Customer Service

• Healthcare Call Center Operations

• Claims Processing

• Appeals Processing

• Health Insurance Operations

• Medical or Administrative Documentation Review

• Data Entry and Records Management

• High-Volume Administrative Processing

• Healthcare Member Services

• Full-time position (40 hours per week).

• Must be available to work Monday through Friday within the operating hours of 8:00 a.m. to 8:00 p.m. AST.

• Must have flexibility to work assigned schedules according to operational needs.

• Availability to work Saturdays, holidays, and regular or mandatory overtime may be required based on business needs.

• Initial training will be conducted on-site.

• Following the training period, employees will transition to a hybrid work arrangement consisting of three (3) days in the office and two (2) days working remotely.

• Temporary-to-hire employment opportunity.

• Anticipated start date: December 7, 2026.

• $14.00 per hour

• Full-time position (40 hours per week)

• Hybrid work opportunity following on-site training

• Temporary-to-hire employment arrangement

If you are a bilingual professional with experience in Healthcare Customer Service, Call Center Operations, or High-Volume Administrative Processing, and possess strong organizational skills, attention to detail, and the ability to manage healthcare-related documentation accurately, we encourage you to apply.

Join an opportunity to develop valuable experience in Healthcare Claims and Appeals Operations while contributing to a structured, professional, and collaborative work environment.

TPIS is an Equal Opportunity Employer (EEO Employer / Affirmative Action for Women, Individuals with Disabilities, and Veterans). We comply with all applicable federal, state, and local laws regarding nondiscrimination in employment.