Medicaid Call Center Jobs in Puerto Rico (NOW HIRING)

Direct Workforce Management, Quality Assurance, and Operational Analytics for Customer Service operations, including Call Centers and Service Centers. Drives workforce strategies to optimize service delivery, productivity, customer experience, and operational efficiency across all channels. Oversees forecasting, capacity planning, scheduling, real‑time operations, quality performance, vendor partnerships, and continuous improvement initiatives. Collaborates across departments to deliver scalable solutions, enhance service performance, ensure compliance, and support business objectives through data-driven decision‑making.

• Lead the unit strategy across all customer contact channels and service delivery platforms, ensuring alignment with organizational goals, customer experience expectations, and regulatory requirements.
• Provide executive leadership with strategic recommendations and performance reporting on workforce effectiveness, quality outcomes, customer experience trends, operational risks, and key business performance indicators.
• Drive innovation in workforce planning and quality programs by evaluating and implementing industry‑leading practices, technology solutions, workforce optimization tools, and emerging customer engagement capabilities.
• Lead continuous improvement initiatives, process optimization, automation, and best‑practice methodologies to improve efficiency, reduce waste, mitigate risks, and enhance customer and employee experiences.
• Develop predictive workforce planning models utilizing historical data, business trends, seasonality, membership 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 metric commitments.
• Leverage operational analytics, business intelligence tools, and performance dashboards to identify trends, risks, productivity opportunities, and actionable insights that support strategic and operational decision‑making.
• Establish and oversee a comprehensive Quality Management framework focused on customer experience, compliance, process effectiveness, and performance improvement opportunities.
• Govern delegated entities and business partner performance, ensuring adherence to performance guarantees, quality standards, contractual obligations, and organizational expectations.
• Identify operational risks, emerging volume trends, service disruptions, and develop mitigation strategies and contingency plans to maintain business continuity and service excellence.
• Ensure compliance with all applicable federal, state, Center for Medicaid and Medicare Services (CMS), Medicare, Medicaid, Health Insurance Portability and Accountability Act (HIPAA), and organizational requirements by integrating regulatory expectations into workforce and quality management practices.
• Enhance cross‑functional collaboration with Call Center teams and partner with other departments to improve service delivery and operational effectiveness.
• Supervises, monitors, trains, evaluates, and corrects personnel among others to comply with his/her role as a supervisor, to assure that his/her personnel fulfill their work plan and comply with their essential functions and that they behave following the policies, standards, norms, and procedures of the Company.
• 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.

Education and Experience: Master’s Degree in Business Administration, Data Analytics, Industrial Engineering, Finance, Healthcare Administration or related fields. At least five (5) years of experience in the management of Call Center Operations developing and implementing workforce optimization strategies that improve service levels, productivity, customer experience, and operational efficiency. At least two (2) years of experience supervising personnel.

OR

Education and Experience: Bachelor’s Degree in Business Administration, Data Analytics, Industrial Engineering, Finance, Healthcare Administration or related fields. At least seven (7) years of experience in the management of Call Center Operations developing and implementing workforce optimization strategies that improve service levels, productivity, customer experience, and operational efficiency. At least four (4) years of experience supervising personnel.

“Proven experience may be replaced by previously established requirements.”

Certifications / Licenses: A valid Customer Experience Professional Certification (CCXP), or Lean Six Sigma Green Belt, or Customer Operations Performance Center Certification (COPC), or Society of Workforce Planning Professionals Certification (SWPP), or International Customer Management Institute Certification (ICMI), or NICE Workforce Management software Certification, or Verint Workforce Management and Quality Monitoring Certification are preferred.

Other: Advanced knowledge of Excel.

Spanish – Advanced (comprehensive, writing and verbal)

English – Advanced (comprehensive, writing and verbal)

“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.