mcs

Especialista De ContratacionRegularExemptGENERAL DESCRIPTION:Responsible for executing processes related to contracting professional service providers, which includes conducting market analysis to ensure compliance with the contracting policy and regulatory standards. Coordinate visits, negotiate agreements, and manage contracts for providers and the...

Supervisor(a) De Servicio ConciergeRegularExemptGENERAL DESCRIPTION:The Concierge Service Supervisor is responsible for overseeing all service situations referred to the Concierge area until a final solution is reached. Communicates the outcome to other departments, if necessary. Coordinates with the facility or the provider and guarantees that the...

Director(a) De Centro De Llamadas OutboundRegularExemptGENERAL DESCRIPTION:Direct and oversee the strategy, performance, and continuous improvement of Customer Retention, Customer Success, and Customer Resolution operations. Responsible for driving member satisfaction, loyalty, retention, service recovery, and operational excellence through inbound and...

Analista De CompensacionRegularExemptGENERAL DESCRIPTION:Responsible for providing professional guidance and support in the administration and operational aspects of compensation programs. Research job requirements and evaluate job positions to ensure the company is competitive in the areas of compensation through collecting, analyzing, and maintaining...

Especialista De CalidadRegularExemptGENERAL DESCRIPTION:The Quality Specialist monitors processes and analyzes the compliance of internal operational areas with the standards and reference requirements, such as those related to accreditation and Model of Care (MOC), among others. Ensures an adequate revision process, compilation of information, and...

Representante De Servicio Al Cliente I-CCRegularNon-ExemptGENERAL 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...

Coordinador(a) De Apoyo De VentasRegularNon-ExemptGENERAL DESCRIPTION:Responsible for coordinating and managing all documentation required for the successful implementation of new business groups. This includes ensuring timely and accurate processing of post-sale documents such as cost sheets, benefit summaries, memos, underwriting invoices, intake...

Representante De Servicio I - CS - CaguasRegularNon-ExemptGENERAL DESCRIPTION:The Customer Service Representative I – SC is responsible for assisting customers and prospects with information about the company's products and services. They address and clarify any questions from beneficiaries who have concerns. Resolves service needs by following established...

Director(a) De Mejora De Procesos EmpresarialesRegularExemptGENERAL DESCRIPTION:The Enterprise Process Improvement Director is responsible for the direction, coordination, implementation, execution, control, and completion of enterprise process improvement initiatives across the organization. Investigates and analyzes business processes, identifies...

Temporary - Internship Exempt Participates in the management and delivery of a variety of projects designed from or assigned to the department. **ESSENTIAL FUNCTIONS:** - Complies with a detailed work plan for each project assigned, consisting of the corresponding implementation phases, projected time frames, process owners, and status...

Regular Non-Exempt **GENERAL DESCRIPTION:** Responsible for resolving service cases received from various sources, including email, voicemail, fax, and internal referrals, that are processed according to established operational procedures and service guidelines to ensure the continuity of services offered by Customer Service. Handles phone calls...

Regular Exempt **GENERAL DESCRIPTION:** The Clinical Operations Monitoring Analyst is responsible for monitoring operational and regulatory processes to ensure compliance with applicable requirements, quality standards, and organizational policies. Supports operational excellence through data analysis, performance monitoring, reporting, process...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for providing a variety of tasks that guide and position data-intensive projects/programs for success. This is accomplished by understanding data requirements, coordinating work across IT, and ensuring resources are following appropriate practices and enterprise standards. This role may also be...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for managing the implementation of Network Management strategies and initiatives that support the organization's business objectives and departmental goals. Oversees operational and contracting activities, provider relations, medical management initiatives, and team performance to ensure...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for planning, implementing, and monitoring all tasks of the configurations unit that are related to the Clinical Affairs department. Documents and evaluates the unit´s operational processes to ensure compliance with the company’s objectives, procedures, and relevant regulations. Works closely...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for collecting, validating, and analyzing utilization, claims, benefits, and demographic information for fully insured group health and life insurance accounts. Supports the renewal process by preparing claim projections, evaluating plan utilization trends, and providing data-driven analyses...

Non-Exempt Regular **GENERAL DESCRIPTION:** Analyzes claims and/or adjustments submitted in Centers for Medicare and Medicaid Services Form 1500 (CMS‑1500) and Uniform Billing Form 04 (UB‑04) formats, as well as member reimbursements, by applying payment rules to determine appropriate adjudication, denial, or the need for additional...

Regular Exempt **GENERAL DESCRIPTION:** Responsible for leading the analysis, interpretation, and evaluation of utilization, claims, benefits, and risk information for fully insured group health and life insurance accounts. Develops renewal rate strategies, validates pricing methodologies, recommends risk assumptions, and drives improvements to...