Ejecutivo(a) De Cuentas Externo

MCS Health; San Juan (PR); On-site; USD 42,000 - 66,000; Full time

Job summary

MCS Health in Puerto Rico seeks a renewals coordinator to represent the company in negotiations with clients, producers, and underwriters. You will coordinate renewal proposals, present data, and ensure accurate system updates for group records and benefits.

Responsibilities include delivering proposals, educating clients on new programs, managing documentation, facilitating certifications, and maintaining strong relationships across the group book of business while adhering to OC S and HIPAA

Qualifications

• Education: Bachelor's in Business Admin, Public Admin, Health Services Admin or related field; 1+ year in healthcare insurance customer service or account management preferred.
• OR: Associate's degree with 3+ years in healthcare insurance customer service or related functions preferred.
• Licenses: Puerto Rico Driver's license required; must obtain OC S licenses (Health, Disability & Health, Life).
• Timeframe: Licenses must be obtained within 6 months for new hires; six months for current employees with provisional license.
• Examination: Pass licensing exams on first attempt; additional attempts at employee's expense.
• Other: Car required; travel within Puerto Rico.

Responsibilities

• Develop initiatives to present renewal proposals to producers and/or clients.
• Presents and discusses proposals with clients/producers and provides data analyses and market trends.
• Identify changes and programs to improve group retention.
• Coordinate and validate benefits and renewals in the system with implementation.

Skills

Spanish language

English language

Education

Bachelor's degree

Associate's degree

Job description

Represents the company in official service negotiations with assigned group. Attend, channel, and solve the different situations from customers, underwriters, and producers as required. Responsible for coordinating and negotiating with the underwriting department the renewal proposal of groups assigned to their Book of Business (BOB).

ESSENTIAL FUNCTIONS:

• Develop initiatives to present renewal proposals to producers and/or clients. Prepares all documentation related to the renewal proposal for submission to the producer and/or group and ensures completion of the administrative process and renewal documents (e.g., obtain the cost sheet signed).


• Presents and discusses proposals with the client/producer and presents experiences or data analysis reports to the group/producers according to the frequency and size of the group, including recommendations and market trends.


• Identifies and includes recommendations for appropriate changes and/or programs to achieve group retention.


• Notifies the implementation department of the agreements with the client/ broker through the established process and forwards any changes. Validate that benefits in the system are entered correctly for new groups and ensure that any changes agreed upon in the group renewal are implemented.


• Coordinates the delivery of cards, presentations, and information booths, along with other activities related to client renewals. Handles the issuance and delivery of Certificates of Coverage to groups as needed and oversees the distribution of directories and any additional materials requested by the group or producer. Facilitate educational interventions in conjunction with other clinical initiatives programs, coordination of benefits, corporate presentations, web pages, and other applicable resources for the assigned segment.


• Timely management, referral, and resolution of sensitive service cases and related matters reported by designated group managers (employers), policyholders, and producers are consistently executed.


• Prepares and coordinates a schedule of service visits with the clients, agent, and/or producer to establish and strengthen good business relationships, including but not limited to information booths and others. Prepares, completes, and submits documents, recording visits, agreements, requests, individual work plans with each assigned group, and experience report, and maintains documentation and client’s record.


• Delivers and provides orientations about the administrative manual, tools, and/or materials to new and current clients.


• Prepares and delivers orientation presentations to employees on benefits, cost containment, new programs and initiatives, according to the schedule established with the client and/or producer. Participates in conventions, health fairs, after-hours activities, and meetings with the producer and employers as required to establish a work plan for the assigned accounts.


• Refer documents to various departments, follows up, and ensure resolution of any service issues reported by employers, policyholders, and producers, while communicating case resolutions to the relevant parties.


• Oversee and handle the designation of authorized Representative documents as required by the Health Insurance Portability and Accountability Act (HIPPA) regulation.


• Creates and keeps updated group files in the central file according to the established protocol.


• It is a requirement to commit and actively participate in recurring continuing education courses and webinars from the Office of the Commissioner of Insurance (OCS) to ensure compliance with all requirements necessary to obtain and renew the licenses required for the successful performance of the position's essential functions.


• 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, Public Administration, Health Services Administration, or related fields. At least one (1) year of experience in customer service, account management, or performing similar functions in the Healthcare Insurance Industry is preferred.

OR

Education and Experience: Associate's Degree. At least three (3) years of experience in customer service, account management, or performing similar functions in the Healthcare Insurance Industry is preferred.

Certifications / Licenses: A Driver's License valid in the Commonwealth of Puerto Rico is required. Candidates or current employees who do not possess the required Office of the Commissioner of Insurance (OCS) licenses (Health Services, Disability and Health, and Life) must commit to obtain the required licenses by successfully passing the examination(s) administered by the Office of the Commissioner of Insurance (OCS).

Timeframe for New Employees: Newly hired employees must obtain the required licenses within six (6) months of their hired date following the issuance of a provisional license.

Timeframe for Current Employees: Current employee’s who are issued a provisional license must obtain the required license(s) within six (6) months of the provisional license issuance date.

Examination Requirement: Employee’s must successfully pass the licensing examination(s) on the first examination(s) attempt paid by the Company. Any additional examination(s) attempts will be employee’s responsibility.

Other: Car in good condition and available to travel to different locations in Puerto Rico.

Languages:

Spanish – Advanced (writing, conversational, and comprehension)

English – Intermediate (writing, conversational, and comprehension)

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.