mcs

Regular Exempt GENERAL 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 improvement opportunities, and leads initiatives...

Regular Exempt GENERAL 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 distribution of documents...

Regular Non-Exempt 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 service continuity and...

Regular Exempt GENERAL 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 coordinated service is provided as...

Regular Non-Exempt GENERAL 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 applications, eligibility files,...

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 company. Participates in the management of...

Regular Exempt GENERAL DESCRIPTION: Responsible for supporting providers in identifying opportunities for improvement and promoting the optimal quality of service to our members through direct and regular contact with them and their work teams. Serves as the main link between physicians and the Company to build and maintain a close business relationship...

Regular Exempt GENERAL DESCRIPTION: The VIP Network Specialist is responsible for developing lasting relationships with providers, specialists, and their office staff, bringing clinical project information, and identifying and addressing situations between the insurer and the provider. Creates communication links between specialists and primary care...

Regular Non-Exempt GENERAL DESCRIPTION: Responsible for coordinating, routing, and following up on operational requests related to the department and/or unit. Provides administrative support, manages documentation, and ensures compliance with internal processes and regulatory requirements, contributing to operational efficiency and service...

Regular Exempt GENERAL DESCRIPTION: Administers, manages, and monitors the operation of the Contracting area to guarantee compliance with organizational goals, following the applicable regulations for each line of business and the contracting and credentialing policy. Oversee the operation and experience of contracting end-to-end Providers and determine...

Regular Exempt GENERAL DESCRIPTION: Supports regulatory compliance through audit readiness, regulatory reviews, corrective action plan management, and monitoring of provider network activities, including contracting, credentialing, and recredentialing. Responsible for monitoring and analyzing metrics, key performance indicators (KPIs), and operational...

Regular Exempt GENERAL DESCRIPTION: The Concierge Service Manager leads the Concierge Services team, overseeing a multidisciplinary team to deliver exceptional service and care coordination for VIP members and commercial clients. Responsible for operational performance, service quality, stakeholder management, and issue resolution, this role ensures...

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 effective execution,...

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 with...

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 information. This...

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 underwriting...

Regular Non-Exempt GENERAL DESCRIPTION: Coordinates and ensures the efficient handling and distribution of service-related cases within the unit. Supports account executives by managing case flow, maintaining accurate records, and providing direct client support. Ensures timely responses to inquiries related to medical, pharmacy, and dental services,...

Regular Exempt GENERAL DESCRIPTION: The Concierge Care Management Specialist effectively reviews VIP member medical requests and determines the correct medical specialty for clinical referrals to maintain optimal level of access to services according to established requirements and timelines. This role acts as a clinical resource for the Concierge...

Regular Exempt GENERAL DESCRIPTION: Analyze claims and payment data to ensure payment integrity and cost containment within the unit. Responsible for preparing reports and converting the regulatory data into useful and actionable information to support management in decision-making and achieve the company's business objectives. ESSENTIAL FUNCTIONS: •...

Regular Exempt GENERAL DESCRIPTION: The Junior Account Executive serves as the primary point of contact for an assigned portfolio of low-complexity accounts, building and maintaining strong client relationships through proactive service, effective communication, and timely resolution of customer needs. This role coordinates cross-functional resources to...