Case Reviewer I/Customer Support Representative

Job Overview

Capitol Bridge Puerto Rico is currently seeking an Onsite Case Reviewer I/Customer Support Representative to join our team in Isabela, Puerto Rico.

As a CSR/CR1, you will play a pivotal role in ensuring exceptional customer support and efficient administrative case review. You will review Workers Compensation Medicare Set-Aside (WCMSA) proposals, including medical records, to determine if the proposal meets CMS threshold requirements. In this position, you will also be responsible for answering phone calls, addressing customer inquiries, and performing basic administrative duties.

Location: On-Site –Isabela, Puerto Rico

Pay and Benefits:

Compensation: $17.75 per hour plus $4.93 H&W

• 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.

• Employee Assistance Program

Health & Welfare (H&W) dollars - also referred to as fringe dollars - are contributed by your employer to help pay for your benefit coverage as required by the Service Contract Act obligation. There is an H&W contribution for every hour you are paid (including PTO, but excluding overtime hours) up to 40 hours per week or as defined by the applicable wage determination. This H&W contribution is utilized to pay for benefits.

Responsibilities:

Customer Support

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.

Case Review

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.

Administrative Duties

Maintain organized and up-to-date records of customer interactions and case reviews.

Other duties as assigned by management.

Team Collaboration

Collaborate with the team to identify areas for process improvement.

Contribute to a positive and collaborative team environment.

Job Requirements

Education & Experience

• High School Diploma or GED required; Associate degree or coursework in Healthcare Administration, Paralegal Studies, or a related field preferred.
• 1+ years of customer service experience (call center or inbound phone support) required.
• Prior experience handling medical records, insurance claims, or legal documentation is strongly preferred.
• Basic understanding of Workers' Compensation, Medicare Set-Aside (MSA) proposals, or CMS guidelines is a plus.

Technical & Operational Skills

• 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.

Communication & Interpersonal Skills

• 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.

Work Style & Adaptability

• 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.

Reasonable Accommodation

If you require alternative methods of application or screening, please contact us directly. To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions. Other duties may be assigned.

EEO Statement

Capitol Bridge Puerto Rico is an Equal Opportunity Employer. All employment decisions at CBHS are based on business needs, job requirements, and individual qualifications, without regard to race, color, religion or belief, national, social or ethnic origin, sex (including pregnancy), age, physical, mental or sensory disability, HIV status, sexual orientation, gender identity and/or expression, marital, civil union or domestic partnership status, past or present military service, family medical history or genetic information, family or parental status, or any other status protected by the laws or regulations in the locations where we operate.

Texting Notice

We communicate with applicants via text in addition to email and phone. If you apply for this position, we may text you regarding your application or other relevant updates. You may opt out at any time.