Coordinador(a) De Servicio

MCS Health; San Juan (PR); On-site; USD 32,000 - 42,000; Full time

Job summary

MCS Health in Puerto Rico is seeking a service coordination specialist to distribute and track client cases across medical, pharmacy, and dental services. You will support account executives, respond to eligibility inquiries, and prepare documentation for coverage and COBRA programs.

Ideal candidates have a degree in business or health services and 6–12 months of related coordination experience, with bilingual Spanish/English proficiency.

Qualifications

• Bachelor’s Degree in Business Administration, Health Services Administration, or related field.
• At least 6 months of coordination, clerical, and/or sales duties, preferably in healthcare insurance.
• Associate’s Degree or 60–64 college credits with 1 year of relevant experience.
• High School Diploma or Technical Course with 2+ years of related experience.
• Proven experience may be replaced by previously established requirements.
• Certifications / Licenses: N/A.
• Languages: Spanish – Intermediate; English – Intermediate.

Responsibilities

• Coordinate and assign incoming service cases to account executives by type (medical, pharmacy, dental PA, eligibility, COBRA).
• Ensure uniform distribution of cases among executives and VIP groups.
• Generate and maintain case logs and reports for management.
• Respond to eligibility inquiries by phone or email and review enrollment forms.
• Process medical plan card requests and prepare coverage certification documents.
• Monitor and adjust case assignments based on staffing and volume.
• Validate clinical authorization details and escalate complex cases to management.
• Facilitate in-person document delivery at the lobby upon request.
• Route cases via RightFax and email; support special initiatives as needed.
• Comply with all policies, procedures, laws, and industry regulations.

Skills

Coordination

Clerical work

Sales support

Healthcare insurance

Education

Bachelor’s Degree in Business Administration

Associate’s Degree or 60–64 college credits

High School Diploma or Technical Course

Job 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, eligibility, and coverage, while also assisting with special initiatives and maintaining service quality standards.

ESSENTIAL FUNCTIONS:

• Coordinate and assign incoming service cases received via the Employer Services inbox to account executives, identifying the nature of each case, whether related to medical prior authorization (PA), pharmacy PA, dental PA, medication coverage clarification, reimbursement inquiries, provider service issues, Consolidated Omnibus Budget Reconciliation Act (COBRA) management, or eligibility verification.
• Ensure a uniform distribution of cases among internal account executives, considering the number of executives available; considering that two account executives are assigned to specific VIP groups, handling all cases received from these groups.
• Generate and maintain case logs and reports detailing received and assigned cases for review by management.
• Respond to eligibility-related inquiries from clients or producers via phone or email, including reviewing enrollment forms and determining appropriate responses based on case complexity.
• Process medical plan card requests submitted by producers, clients, or account/sales executives, ensuring timely issuance and delivery.
• Prepare coverage certification documents for all client types, including insured groups and Administrative ServicesOnly (ASO) accounts, covering both Puerto Rico and U.S.-based students.
• Monitor and adjust case assignments, responding to changes in staffing and case volume to maintain workflow efficiency.
• Review and validate clinical authorization case details to ensure accurate assignment to the appropriate internal resource.
• Facilitate document delivery in-person, including ID cards or other requested materials, at the lobby upon client or internal request.
• Escalate sensitive or complex cases to management, providing visibility into issues that may require higher-level intervention or decision-making.
• Contact clients or producers by phone as needed to provide general information.
• Route incoming cases received via RightFax and email, ensuring proper categorization and timely assignment, while also supporting special initiatives as needed.
• Must comply fully and consistently with all company policies and procedures, with local and federal laws as well as with the regulations applicable to our Industry, to maintain appropriate business and employment practices.
• May carry out other duties and responsibilities as assigned, according to the requirements of education and experience contained in this document.

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor’s Degree in Business Administration, Health Services Administration, or a related field. At least six (6) months ofexperience performing coordination, clerical, and/or sales-related duties, preferably in the Healthcare Insurance industry.

OR

Education and Experience: Associate's Degree or at least sixty to sixty-four (60-64) approved college credits. At least one (1) year of experience performing coordination, clerical, and/or sales-related duties, preferably in the Healthcare Insurance industry.

OR

Education and Experience: High School Diploma or Technical Course. At least two (2) years of experience performing coordination, clerical, and/or sales related duties, preferably in the Healthcare Insurance industry.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: N/A

Other: N/A

Languages:

Spanish – Intermediate (comprehensive, writing and verbal)

English – Intermediate (comprehensive, writing and verbal)

“We are an Equal Employment Opportunity Employer and take affirmative Action to recruit Protected Veterans and Individuals with Disabilities.”

MCS Healthcare Holdings, LLC. (MCS)is an Equal Employment Opportunity Employer and take affirmative Action to recruit Protected Veterans and Individuals with Disabilities. MCS is a participating E-Verify employer.