Clinical Operations Monitoring & Compliance Analyst

MCS Puerto Rico; San Juan (PR); On-site; USD 65,000 - 95,000; Full time

Job summary

MCS Puerto Rico seeks a Clinical Operations Monitoring Analyst to oversee operational and regulatory processes, ensuring compliance with federal, state, contractual, and organizational requirements. The role supports excellence through data analysis, performance monitoring, reporting, and quality oversight.

You will analyze KPIs, develop recommendations, and provide timely reporting to leadership while supporting CAPs, audits, and cross-functional process improvements.

Qualifications

• Bachelor’s degree in Business Administration, Health Services Administration, or related areas.
• Minimum of three (3) years of experience supporting Medicare Advantage and Medicaid in health care operations, health insurance, regulatory compliance, grievances and appeals, claims administration, clinical operations, process improvement, reporting, quality management.

Responsibilities

• Monitor operational and regulatory processes to ensure compliance with applicable federal, state, contractual, and organizational requirements.
• Analyze performance metrics, KPIs, trends, and operational data to identify opportunities for improvement and mitigate risks.
• Develop, maintain, validate, and standardize operational and regulatory reports, dashboards, scorecards, and presentations for leadership and operational committees.
• Support corrective action plans (CAPs); perform root cause analyses and recommend corrective actions to improve performance and compliance.
• Monitor quality standards through audits, sampling methodologies, and process reviews to ensure accurate categorization, documentation, investigation, and timely resolution of cases.
• Identify concerns and escalate findings to management for appropriate action.
• Participate in regulatory audits, readiness activities, and data validation exercises as required.

Skills

Excel

Reporting tools

Operational software

Education

Bachelor’s degree in Business Administration, Health Services Administration, or related areas

Tools

Excel

Reporting tools

Job description

MCS Puerto Rico seeks a Clinical Operations Monitoring Analyst to oversee operational and regulatory processes, ensuring compliance with federal, state, contractual, and organizational requirements. The role supports excellence through data analysis, performance monitoring, reporting, and quality oversight.

You will analyze KPIs, develop recommendations, and provide timely reporting to leadership while supporting CAPs, audits, and cross-functional process improvements.