Medicaid Call Center Jobs in Puerto Rico (NOW HIRING)

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FULL TIME San Juan, PR, PR

24 days ago Requisition ID: 2155

Salary Range: $70,000.00 To $80,000.00 Annually

A leading organization in the health insurance industry is seeking a strategic leader to oversee Workforce Management, Quality Assurance, and Operational Analytics for its customer service operations, including call centers and service centers.

The selected candidate will develop and implement strategies to optimize service delivery, productivity, customer experience, and operational efficiency across all customer contact channels. This role is responsible for forecasting, capacity planning, staffing, scheduling, real-time operations, quality performance, operational analytics, and business partner oversight.

This position requires executive-level leadership, strong analytical capabilities, and proven experience transforming operational data into scalable strategies and solutions within a complex, highly regulated environment.

• Lead the Workforce Management, Quality Assurance, and Operational Analytics strategy across all customer contact channels and service delivery platforms.
• Align the unit’s strategies with organizational goals, customer experience expectations, and applicable regulatory requirements.
• Provide executive leadership with strategic recommendations and reports concerning workforce effectiveness, quality results, customer experience trends, operational risks, and key business performance indicators.
• Develop predictive workforce planning models using historical data, business trends, seasonality, growth projections, regulatory requirements, and operational demand drivers.
• Direct forecasting, capacity planning, staffing, scheduling, and real-time management activities to optimize resource utilization and achieve service-level and performance commitments.
• Leverage business intelligence tools, dashboards, and operational analytics to identify trends, risks, productivity opportunities, and actionable insights.
• Establish and oversee a comprehensive Quality Management framework focused on customer experience, compliance, process effectiveness, and performance improvement.
• Evaluate and implement industry-leading practices, workforce optimization tools, and emerging customer engagement technologies.
• Lead continuous improvement, automation, and process optimization initiatives to increase efficiency, reduce waste, mitigate risk, and enhance the customer and employee experience.
• Oversee the performance of vendors, delegated entities, and business partners, ensuring compliance with quality standards, performance guarantees, contractual obligations, and organizational expectations.
• Identify operational risks, emerging volume trends, and potential service disruptions, and develop mitigation and business continuity plans.
• Integrate applicable CMS, Medicare, Medicaid, HIPAA, federal, and local requirements into workforce and quality management practices.
• Partner with call center leaders and cross-functional teams to strengthen service delivery and operational effectiveness.
• Supervise, develop, train, and evaluate assigned personnel, ensuring accountability for work plans, performance expectations, and essential job responsibilities.
• Comply with all organizational policies and procedures and with applicable laws and industry regulations.
• Perform other related duties as assigned based on organizational needs.

Option 1

• Master’s degree in Business Administration, Data Analytics, Industrial Engineering, Finance, Healthcare Administration, or a related field.
• At least five (5) years of management experience in call center operations.
• Demonstrated experience developing and implementing workforce optimization strategies that improve service levels, productivity, customer experience, and operational efficiency.
• At least two (2) years of personnel supervisory experience.

Option 2

• Bachelor’s degree in Business Administration, Data Analytics, Industrial Engineering, Finance, Healthcare Administration, or a related field.
• At least seven (7) years of management experience in call center operations.
• Demonstrated experience developing and implementing workforce optimization strategies that improve service levels, productivity, customer experience, and operational efficiency.
• At least four (4) years of personnel supervisory experience.

• Advanced proficiency in Microsoft Excel.
• Experience with forecasting, capacity planning, staffing, scheduling, and real-time workforce management.
• Ability to interpret complex operational data and translate findings into strategic recommendations.
• Experience developing performance indicators, dashboards, and executive-level reports.
• Knowledge of Quality Assurance programs and continuous improvement methodologies.
• Strong leadership, communication, collaboration, problem-solving, and decision-making skills.
• Advanced proficiency in Spanish and English, both written and spoken.

One or more of the following active certifications are preferred:

• Certified Customer Experience Professional (CCXP)
• Customer Operations Performance Center (COPC)
• Society of Workforce Planning Professionals (SWPP)
• International Customer Management Institute (ICMI)
• NICE Workforce Management
• Verint Workforce Management or Quality Monitoring

TPIS is an Equal Opportunity Employer (EEO Employer / Aff…