Health Care Admin Representative – San Juan, PR
UHG Format Pro
Requisition Number: 2282716
Job Category: Medical & Clinical Operations
Location: San Juan, Puerto Rico, US
Position Overview:
Join Optum, a global health services leader, in a role that directly impacts health outcomes and drives equity through effective care coordination. As a Health Care Admin Representative within the Home and Community-Based Services department, you will handle the initial triage of members, intake processes, and manage authorization and referral workflows in a clinical setting. This position requires strong communication and organizational skills, along with a dedication to service and accuracy.
Primary Responsibilities:
Manage inbound and outbound calls related to prior authorizations and service requests.
Input and update authorizations, verify requirements, and provide status updates to patients and providers.
Act as the primary contact for members and providers regarding services and benefits.
Extract and review faxes and electronic referrals for clinical services.
Collaborate with clinical teams to ensure proper follow-up and resolution.
Organize workload to meet daily productivity and quality benchmarks.
Maintain professionalism in handling sensitive health information.
Note: English Proficiency Assessment is required post-application.
Required Qualifications:
1+ year experience in a healthcare setting.
1+ year experience in a production-based environment.
1+ year experience solving customer issues in office or service environments.
Proficient with Microsoft Word and Excel.
Strong PC skills and familiarity with Windows applications.
Professional proficiency in English.
Available to work 40 hours per week, Monday–Friday, 7:00 AM–8:00 PM AST, with flexibility for occasional overtime, weekends, or holidays.
Ability and willingness to undergo cross-training based on business requirements.
Preferred Qualifications:
Experience with ICD-9/10 and HCPC coding systems.
Familiarity with Managed Care, Medicaid, Medicare, and Commercial insurance regulations.
Strong analytical, problem-solving, and independent decision-making skills.
Proven team collaboration abilities across departments.
Additional Details:
This is a full-time, onsite position.
Offers opportunities for career growth within a mission-driven, diverse, and inclusive organization.
Comprehensive benefits include incentives, 401(k) contributions, stock options, and more.
About UnitedHealth Group:
UnitedHealth Group is committed to helping people live healthier lives and to making the health system work better for everyone. We prioritize equity, inclusivity, and sustainable care practices to address barriers in health and improve patient outcomes across all communities.
Equal Opportunity Employer:
We are an Equal Employment Opportunity / Affirmative Action employer. All qualified applicants will receive consideration without regard to race, color, religion, sex, age, national origin, veteran status, disability, sexual orientation, gender identity or expression, marital status, or any other legally protected status.
Drug-Free Workplace:
All candidates must pass a drug test before beginning employment.
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