MCS Puerto Rico
General Description
Responsible for receiving and initiating phone calls regularly in alignment with the strategies and special projects of the Medicare Stars Program. Ensures the call volume and service quality meet the productivity targets and supports the attainment of Stars-related goals. Solves and forwards situations through the established operational processes and guides. Documents all efforts employed and the service provided to keep a detailed record of the contact made with customers and providers.
Essential Functions
Receives and initiates phone calls regularly in alignment with the strategies and initiatives of the Medicare Stars Program. Ensures the call volume and service quality meet the productivity targets and supports the attainment of Stars-related goals.
Evaluates, solves, and accurately documents the situations presented by policyholders and providers regarding the department's strategies through the call. Forwards service situations to the corresponding operational areas for effective and prompt issue resolution, supporting service satisfaction and quality metrics.
Ensures compliance with the quality standard and Key Performance Indicators (KPIs) established in overseeing the calls received within the unit.
Maintains punctuality and adherence to assigned work schedules to ensure consistent service availability and contribute to unit performance goals.
Complies with and uses the ALVARIA connection system, connects according to their work itinerary and maximizes call time to avoid affecting the Call Center performance metric, answers a predetermined minimum of calls within the required time limit without exceeding the approved percentage of abandonment.
Meets the established documentation parameters in the service provided through the call received and/or dialed.
Prepares and manages documentation related to STARS strategies and initiatives.
Coordinates appointments for policyholders with physicians and health providers as needed and supports the strategies overseen in the call center.
Executes the required follow-ups to ensure service requests are properly channeled and completed, validates documents, or collects necessary information for Stars-related measures.
Provides administrative support to IPA's, PCPs, and various departments in the coordination of member-related activities and Stars-related initiatives.
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: Four‑year high school diploma. At least three (3) years of experience working in customer service areas, preferably in a call center in the health insurance industry.
Education: Sixty (60) university credits equivalent to two (2) years of studies or an associate degree. At least two (2) years of experience working in customer service areas, preferably in a call center in the health insurance industry.
Education: Bachelor’s degree from an accredited institution. At least one (1) year of experience working in customer service areas, preferably in a call center in the health insurance industry.
Proven experience may be replaced by previously established requirements.
Certifications / Licenses Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays. Knowledge of PowerMHS, INFOTEC, COGNOS, Envision Rx, Voyager, Net Claim, Fastrive, BDS, IHealth Claim Inquiry Tool, TruCare, Starstrack, and Provinet.
Languages
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
Equal Employment Opportunity Statement MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and takes affirmative action to recruit protected veterans and individuals with disabilities. MCS is a participating E‑Verify employer.
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Essential Functions
Receives and initiates phone calls regularly in alignment with the strategies and initiatives of the Medicare Stars Program. Ensures the call volume and service quality meet the productivity targets and supports the attainment of Stars-related goals.
Evaluates, solves, and accurately documents the situations presented by policyholders and providers regarding the department's strategies through the call. Forwards service situations to the corresponding operational areas for effective and prompt issue resolution, supporting service satisfaction and quality metrics.
Ensures compliance with the quality standard and Key Performance Indicators (KPIs) established in overseeing the calls received within the unit.
Maintains punctuality and adherence to assigned work schedules to ensure consistent service availability and contribute to unit performance goals.
Complies with and uses the ALVARIA connection system, connects according to their work itinerary and maximizes call time to avoid affecting the Call Center performance metric, answers a predetermined minimum of calls within the required time limit without exceeding the approved percentage of abandonment.
Meets the established documentation parameters in the service provided through the call received and/or dialed.
Prepares and manages documentation related to STARS strategies and initiatives.
Coordinates appointments for policyholders with physicians and health providers as needed and supports the strategies overseen in the call center.
Executes the required follow-ups to ensure service requests are properly channeled and completed, validates documents, or collects necessary information for Stars-related measures.
Provides administrative support to IPA's, PCPs, and various departments in the coordination of member-related activities and Stars-related initiatives.
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: Four‑year high school diploma. At least three (3) years of experience working in customer service areas, preferably in a call center in the health insurance industry.
Education: Sixty (60) university credits equivalent to two (2) years of studies or an associate degree. At least two (2) years of experience working in customer service areas, preferably in a call center in the health insurance industry.
Education: Bachelor’s degree from an accredited institution. At least one (1) year of experience working in customer service areas, preferably in a call center in the health insurance industry.
Proven experience may be replaced by previously established requirements.
Certifications / Licenses Knowledge of medical billing, preferably. Availability to work rotating shifts, Saturdays, Sundays, and holidays. Knowledge of PowerMHS, INFOTEC, COGNOS, Envision Rx, Voyager, Net Claim, Fastrive, BDS, IHealth Claim Inquiry Tool, TruCare, Starstrack, and Provinet.
Languages
Spanish – Intermediate (comprehensive, writing and verbal)
English – Intermediate (comprehensive, writing and verbal)
Equal Employment Opportunity Statement MCS Healthcare Holdings, LLC. (MCS) is an Equal Employment Opportunity Employer and takes affirmative action to recruit protected veterans and individuals with disabilities. MCS is a participating E‑Verify employer.
#J-18808-Ljbffr