Clinical Operations Jobs in Puerto Rico (NOW HIRING)

Carelon Global Solutions (CGS), a fully owned subsidiary of Elevance Health, is a healthcare solutions company that is simplifying complex operational processes to improve the health of the healthcare system.

CGS is a Global Capability Center (GCC) that leverages a strong talent base internationally to achieve strategic goals.

CGS organization has undergone tremendous growth over the last 8-years (with over 25,000 associates presently in Philippines, India, and Puerto Rico).

Location: San Juan, Puerto Rico

This role requires associates to be in-office at least 3days per week, fostering collaboration and connectivity, while providing flexibility to support productivity and work-life balance. This approach combines structured office engagement with the autonomy of virtual work, promoting a dynamic and adaptable workplace. Alternate locations may be considered. Please note that per our policy on hybrid/virtual work, candidates not within a reasonable commuting distance from the posting location(s) will not be considered for employment, unless an accommodation is granted as required by law.

Responsible for leadership and overall accountability for the strategy, performance, and operations of Carelon Global Solutions (CGS) Puerto Rico. Responsible for positioning the organization as a high-performing, scalable delivery center that supports enterprise business objectives, evolving operational needs, and long-term growth.

• Oversight across a diverse portfolio of healthcare and business operations, including contact center and customer service functions, claims administration, clinical support, benefits administration, and other core business services.

• Accountable for operational performance, financial results and P&L management, service quality, compliance, workforce effectiveness, and the strategic roadmap to strengthen business performance and support growth.

• Drives execution and promotes continuous improvement across CGS Puerto Rico operations.

• Ensures teams achieve performance, quality, service, and compliance expectations while identifying opportunities to improve efficiency, accuracy, scalability, and the member and customer experience.

• Ensures strategic initiatives are successfully implemented and deliver measurable business outcomes.

• Maintains governance, compliance, and operational risk management.

• Serves as the relationship owner for key vendors, outsourcing partners, and strategic business relationships.

• Advocate and liaison for external stakeholder relationships.

• Hires, trains, coaches, counsels, and evaluates performance of direct reports.

• Travel as needed to support enterprise stakeholders, operations, and key relationships.

Requires a BA/BS and minimum of 15 years professional/leadership experience; or any combination of education and experience, which would provide an equivalent background.

• Strategic leadership & roadmap ownership

  • Setting direction for strategy and astrategic roadmap, aligning operations to evolving business needs and long-term growth.

• Operational excellence

  • Driving execution; managing performance toquality, service levels, compliance, efficiency, and accuracy.

  • Building systems forworkforce effectivenessand consistent delivery.

• Continuous improvement & transformation

  • Identifying improvement opportunities and leading initiatives that measurably improve scalability and customer/member experience.

• Outcome-focused program/initiative execution

  • Implementing strategic initiatives end-to-end and deliveringmeasurable business outcomes(not just activity).

• Stakeholder management & influence

  • Acting as anadvocate and liaisonwith external stakeholders; strong communication, alignment, and escalation management.

• Leadership pipeline & talent development at scale

  • Demonstrated capability to mentor leaders, build succession plans, and develop a strong leadership bench within a large, evolving organization—beyond day-to-day people management.

• Advanced financial/analytical and change leadership.

  • Strong financial and analytical skills paired with disciplined change management—experienced leading organizational change and process improvement through structured methodologies, data, and measurable benefits realization.

• Vendor management

  • Relationship ownership with vendors/outsourcing partners; service governance and performance management.

• MBA preferred.

Corporate Title: Staff VP Puerto Rico CGS Operations

Please be advised that Elevance Health only accepts resumes for compensation from agencies that have a signed agreement with Elevance Health. Any unsolicited resumes, including those submitted to hiring managers, are deemed to be the property of Elevance Health.

Elevance Health is a health company dedicated to improving lives and communities – and making healthcare simpler. We are a Fortune 25 company with a longstanding history in the healthcare industry, looking for leaders at all levels of the organization who are passionate about making an impact on our members and the communities we serve.

At Elevance Health, we are creating a culture that is designed to advance our strategy but will also lead to personal and professional growth for our associates. Our values and behaviors are the root of our culture. They are how we achieve our strategy, power our business outcomes and drive our shared success - for our consumers, our associates, our communities and our business.

We offer a range of market-competitive total rewards that include merit increases, paid holidays, Paid Time Off, and incentive bonus programs (unless covered by a collective bargaining agreement), medical, dental, vision, short and long term disability benefits, 401(k) +match, stock purchase plan, life insurance, wellness programs and financial education resources, to name a few.

Elevance Health operates in a Hybrid Workforce Strategy. Unless specified as primarily virtual by the hiring manager, associates are required to work at an Elevance Health location at least once per week, and potentially several times per week. Specific requirements and expectations for time onsite will be discussed as part of the hiring process.

The health of our associates and communities is a top priority for Elevance Health. We require all new candidates in certain patient/member-facing roles to become vaccinated against COVID-19 and Influenza. If you are not vaccinated, your offer will be rescinded unless you provide an acceptable explanation. Elevance Health will also follow all relevant federal, state and local laws.

Elevance Health is an Equal Employment Opportunity employer and all qualified applicants will receive consideration for employment without regard to age, citizenship status, color, creed, disability, ethnicity, genetic information, gender (including gender identity and gender expression), marital status, national origin, race, religion, sex, sexual orientation, veteran status or any other status or condition protected by applicable federal, state, or local laws. Applicants who require accommodation to participate in the job application process should submit the Accessibility Accommodation Request Form and a member of the team will be in contact.

Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state, and local laws, including, but not limited to, the Los Angeles County Fair Chance Ordinance and the California Fair Chance Act.

Prospective employees required to be screened under Florida law should review the education and awareness resources at HB531 | Florida Agency for Health Care Administration.