Case Reviewer I

Capitol Bridge Puerto Rico is seeking an on-site CUSTOMER SUPPORT REPRESENTATIVE / CASE REVIEWER 1 (CSR/CR1) for our Isabela site located at 699 Industrial Avenue, Isabela PR 00662.

To prepare you for this endeavor, Capitol Bridge Puerto Rico will offer paid, comprehensive training that will provide you the tools and resources to assist caller(s) with the highest level of service, support, and professionalism.

Excellent Benefits Plan Includes:

• 401K Retirement plan.

• Company sponsored Life Insurance.

• Vacation Leave and Sick Leave dictated by applicable federal and PR labor law.

• Employee Assistance Program

• Paid Training

• Paid Holidays

Overview: 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.

Compensation: $17.75 p/h + $4.93 H&W

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.

Requirements:

• High school diploma or equivalent (Bachelor's degree preferred).

• Previous customer service experience is preferred.

• Strong communication skills, both written and verbal.

• Ability to multitask and prioritize in a fast-paced environment.

• Detail-oriented and organized.

• English/Spanish proficient in speaking, reading and writing.

• Proficient in basic computer applications (e.g., Microsoft Office, Microsoft Teams).

• Willingness to work on-site at our Isabela, PR location

Screenings Requested:

• You may receive requests for background checks and or drug screening regarding this employment opportunity. Respond to all requests quickly as we anticipate filling our vacancies quickly and non-responses may result in disqualification for this opportunity.

Reasonable Accommodation:

• If you require alternative methods of application or screening, you must approach the employer directly to request this.

• To perform this job successfully, an individual must be able to perform each essential duty satisfactorily. The requirements listed are representative of the knowledge, skill, and/or ability required.

• Reasonable accommodations may be made to enable individuals with disabilities to perform essential functions. Other duties may be assigned.

EEO Statement:

• Capitol Bridge PR is an Equal Opportunity Employer. All employment decisions at CBPR 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 Federal Contractor and E-Verify compliant.