Provider Operations & Compliance Specialist

MCS Puerto Rico; San Juan (PR); On-site; USD 50,000 - 70,000; Full time

Job summary

MCS Puerto Rico is seeking a professional to assist in investigating cases for resolution in compliance with applicable regulations and contractual agreements. The role involves supporting the implementation of special networks, prompt payment, and directory complaints, analyzing operational impact and developing action plans to ensure compliant processes.

The position requires collaboration across units, preparation of reports, and effective communication with stakeholders.

Qualifications

• Bachelor's degree in Business Administration; at least two years of experience in data management, report development and analysis.

Responsibilities

• Provides support within the unit regarding timely resolutions of grievances and appeals.
• Participates in design and development of success indicators, operational metrics, and process flow analysis.
• Conducts quality calls and reports findings to management to improve service and resolve complaints.
• Develops progress reports, analyzes data, and follows up on actions.
• Creates files of monitoring efforts and submits them to the appropriate units.

Skills

Data analysis

Reporting

Education

Bachelor's degree in Business Administration

Tools

Excel

Job description

MCS Puerto Rico is seeking a professional to assist in investigating cases for resolution in compliance with applicable regulations and contractual agreements. The role involves supporting the implementation of special networks, prompt payment, and directory complaints, analyzing operational impact and developing action plans to ensure compliant processes.

The position requires collaboration across units, preparation of reports, and effective communication with stakeholders.