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Provider Service Executive
Provider Service Executive-March 2024
San Juan
Mar 28, 2026
About Provider Service Executive

  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.• Document all provider intervention.• Monitor the contractual indicators by providers and development an individual action plan.• Communicate the results of provider claims denials before they occur.• Identify and report findings in writing to the management 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.• Maintains liaison with other departments for issue completion.• Participate in special projects assigned by supervisor.Bachelor’s Degree in Business Administration, Health Science or Marketing, with one (1) to three (3) years of experience, preferably. Or Associates Degree (60-64 college credits) in Business Administration, Health Science or Marketing with three (3) to five (5) years of experience, preferably. Or at least 5 years of this work experience in lieu of.

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