Empleos de mcs en San Juan

Representante de Servicio al Cliente I - CC - copy - copy - copy - copy - copyRegularNon-ExemptGENERAL DESCRIPTION:Responsible for providing an excellent service when answering requests from policyholders, members, and providers through phone calls received. Solves situations or service needs, channeling them through the established operational processes and...

Especialista De Querellas Y ApelacionesRegularExemptGENERAL DESCRIPTION:Analyzes, investigates, supports, and answers Grievances, Dental Pre-Service, and Payment Appeals filed by members, insureds,Providers, and/or Non-Part Providerswithin the time stipulated contractually for both Lines of Business (LOB) and followingthe terms statedin the contracts...

Especialista De Calidad ClinicaRegularExemptGENERAL DESCRIPTIONThe Clinical Quality Specialist is responsible for reviewing and evaluating quality of care concerns, including complaints, internal referrals, CTMs, appeal reconsiderations, and Hospital-Acquired Conditions (HACs). Ensures timely case resolution, oversight of Corrective Action Plans (CAPs),...

Analista De Reclamaciones IRegularNon-ExemptGENERAL DESCRIPTION:Analyzes and processes simple or non?complex professional and institutional claims, including performing data entry, adjudicating payments, issuing denials, and requesting additional information, in accordance with applicable benefits, policy requirements, and within the adjudication authority...

Especialista De Pre-auditorias En Manejo De PrimaRegularExemptGENERAL DESCRIPTION:Performs internal and external audits of Independent Contractors and Providers following the established work plan, monitoring compliance with documentation and clinical coding rules. Identifies situations that may represent a risk in case of a Risk Adjustment audit conducted...

Lider De Innovacion En Farmacia Regular Exempt GENERAL DESCRIPTION: Responsible for driving strategic initiatives that transform pharmacy operations, enhance patient outcomes, and optimize cost-efficiency within the healthcare insurance industry. Leads cross-functional initiatives, implements innovative solutions, and ensures the evolution of pharmacy...

Especialista De Programas Clinicos En Farmacia Regular Exempt GENERAL DESCRIPTION: Responsible for working with Pharmacy Quality Clinical Programs, including Medication Therapy Management Program (MTMP: Comprehensive Medication Review (CMR) & Targeted Medication Review (TMR)), Diabetes Program Medication Reconcilliation Intervention, Specialty Program MD...

Ejecutivo(a) De Cuenta Concierge Regular Exempt GENERAL DESCRIPTION: Responsible for receiving all referral calls and web inquiries from VIP customers, overseeing them courteously and appropriately, and registering them in the appropriate databases. Accountable for developing lasting relationships with customers and their staff by managing clinical project...

Especialista Senior De Calidad Clinica Regular Exempt GENERAL DESCRIPTION: Provides cross-functional collaboration to support the Quality Improvement Program, ensuring timely submissions, adherence to established timelines, and successful execution of quality initiatives. Responsible for the Quality of Care (QOC) process, leads task forces, and serves as the...

Representante de Servicio al Cliente I - CC GENERAL DESCRIPTION: Responsible for providing high-quality customer service to policyholders, members, and providers through inbound calls. Effectively resolves service inquiries in accordance with established operational processes and service guidelines, while accurately documenting all interactions to ensure...

Tecnico(a) de Farmacia / STAR Regular Non-Exempt GENERAL DESCRIPTION: Oversees interventions and/or calls to clients (beneficiaries, providers, pharmacies) to promote the correct use of medications and follow the prescription to increase adherence in the identified population, which results in a significant impact on the star rating for the...

Analista De Elegibilidad Y Afiliacion Classicare Regular Non-Exempt GENERAL DESCRIPTION: Responsible for the accurate and timely administration of enrollment, disenrollment, eligibility, and benefit maintenance processes in compliance with federal, state, Center for Medicare and Medicaid Services (CMS), Puerto Rico Health Services Administration (ASES), and...

Compensation Specialist Regular Exempt GENERAL DESCRIPTION: Provided professional guidance and support in the effective and consistent application of staff job classification and compensation administration policies and practices in accordance with applicable state and federal laws and regulations. Perform effective and consistent job evaluations and salary...

We are looking for a cashier with experience, speed, and accuracy.Food business - Ave. Ponce de León MCS BuildingFull timeFixed shift: Monday to Friday 6:30 a.m. to 2:30 p.m.If you meet the requirements, please contact ************Tipo de puesto: Tiempo completoHoras previstas: 40 por semanaLugar de trabajo: Empleo presencialWork Location: In personTipo de...

Supervisor(a) De Manejo De UtilizacionRegularExemptGENERAL DESCRIPTION:Monitors and oversees the integrated administrative operation of clinical services. Complies and manages adequately and effectively the organization's Precertification process. Measures compliance with operational and quality processes as established. Provides direct supervision to...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for receiving, registering, and forwarding requests for organizational determination and/or any associated clinical documentation or documentation for the clinical management of the insured. Works with the authorizations of services already predetermined through the automatic process using...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for managing administrative tasks, coordinating services, and maintaining compliance with established protocols. Serves as a vital link between members, healthcare providers, and the multidisciplinary team within the organization. Facilitates the delivery of services to members in an...

Estamos muy emocionados de que se una a nuestro equipo de trabajo en Subway Centro Médico y la empresa Caribbean Franchise! Estamos buscando personas como tú, con entusiasmo y deseos de mejoramiento en nuestra cadena de restaurantes. Tenemos una excelente lista de beneficios, con amplias oportunidades de crecimiento personal y profesional. Muchos de...

Estamos muy emocionados de que se una a nuestro equipo de trabajo en Subway Americo Miranda y la empresa Caribbean Franchise! Estamos buscando personas como tú, con entusiasmo y deseos de mejoramiento en nuestra cadena de restaurantes. Tenemos una excelente lista de beneficios, con amplias oportunidades de crecimiento personal y profesional. Muchos de...

Regular Non-Exempt **GENERAL DESCRIPTION:** Receive the Grievances, Pre-Service Appeals, Post-Service Appeals, Payment Disputes, Payment Appeals, and Administrative Organizational Determinations (AOD) filed by Providers and members, as applicable. Responsible for filling and assigning cases to the Specialists in accordance with established time...