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Koltin is redesigning elder and disabled care in Mexico, offering health memberships that combine preventive clinical care, major medical expense coverage, and wellness/community programs for adults aged 50–84. The company is growing rapidly across the country with a mission to make healthcare more human, accessible, and dignified for seniors.
You will serve as an Insurance Operations Analyst focused on claims management, tracking, and resolution. This is a key role ensuring each case is handled timely and properly, with documentation meeting insurer requirements and members receiving quality, timely care throughout the process.
Key Responsibilities:
- Analyze claims requests based on coverage criteria, policies, and insurer guidelines
- Review and analyze medical documentation from members, identifying inconsistencies, missing documents, or information that could lead to rejection
- Provide clear, documented justifications for approval, rejection, or additional information requests to the insurer
- Conduct periodic analysis of claims trends and patterns
Role Objectives:
- Ensure strict compliance with coverage policies, submission timelines, and documentation requirements
- Detect and report irregularities such as incomplete documentation, inconsistent dates, or out-of-coverage cases
- Identify process improvement opportunities in the claims workflow, from member documentation receipt through medical review, aiming to reduce processing times and minimize rejections
- Propose and implement continuous improvements in tracking procedures, insurer communication, and member service
- Collaborate with internal teams to implement technology tools that automate repetitive tasks (documentation review, status tracking, inconsistency detection)
- Participate in designing workflows that reduce human error and improve member response times
- Establish metrics and KPIs to evaluate team performance (processing times, SLA compliance, documentation quality)
- Generate periodic reports analyzing claims trends, review timelines, and improvement recommendations
You are a good fit if you seek to create positive impact, have a disruptive mindset willing to challenge the status quo with creative process optimization, and are passionate about leaving a lasting legacy through meaningful work.
Requirements:
The posting does not explicitly state years of experience, education level, or specific technical certifications required. However, the role expects competency in claims analysis, medical documentation review, policy interpretation, process optimization, and reporting/analytics. Experience with insurance operations, healthcare administration, or similar regulated compliance environments would be relevant.
