Business Validation Specialist

Guaynabo, PR

ABOUT US

At Grupo Triple S, we are committed to provide meaningful job experiences for Valuable People (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

Independently performs tasks that are guided by policies and procedures. Select the best methodology to achieve the outcomes identified in a work plan or project. Responsible for gathering information, undertake analysis and make recommendations that will be used by others to a higher hierarchical level. Collect, organize and present information relevant to a situation or problem, channeling to the supervisor unusual situations or situations not covered by procedures.

WHAT YOU'LL DO

• Analyze, review and validate the information included in the Health Insurance Contract and/or Financial Proposal and related documentation to ensure that all elements are considered as well as the benefits of sale and renewal.
• Review and validate that the premium rates entered or modified in Stepwise are accurate and complete in accordance to the contract and related documentation before is released in the system. Notify the differences to the correspondent areas for correction. For PPACA benefits, the information in Stepwise is verified against the rates approved by the Office of Insurance Commissioner and related documentation.
• Refer documents to Enrollment via SASSS to complete the process.
• Interact with account executives and other parties involved in the negotiation process to clarify doubts related to the negotiations and other matters.
• Validate Group Termination Report.
• Validate Group Modifications during or after installation or renewal period.
• Prepare and update reports, as required.
• Validate and analyze reports, as required.
• Comply with key performance indicators, MTM procedures, Model Audit Rule (MAR) requirements and advice management of any situation that might affect performance.
• Other tasks as assigned by management and that are essential.

WHAT YOU'LL BRING

Bachelor Degree in Business Administration with major in Accounting, Information System or Health related with 1 year of experience in the health insurance industry. Associate Degree (60-64 college credits) in Business Administration with major in Accounting, Statistics, Information System or Health related with one (1) to three (3) years of experience in the health insurance industry. Or three (3) to five (5) years of this experience in areas related to Claims, Enrollment, Configuration, Services, Sales, or Renovations lieu of.

CLOSING DATE: 5/12/2023

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