Productivity Assurance Specialist
Solliciteren
Plaats
Sint-Jans-Molenbeek1080
Brussel
België
Contract
Vooltijds, Onbepaalde duurDatum gepubliceerd
2026-02-12Online to:
2026-04-13EUR 15.00 HOUR
Productivity Assurance Specialist
- MCS Puerto Rico
- Brussel
- 23 uren geleden
Regular
Exempt
GENERAL DESCRIPTION:
Responsible for executing and reviewing quality controls for monitoring the operational processes established in the Unit to process claims and benefit configuration, seeking continuous improvement and quality. Proactively work on the referral and implementation of corrective actions with the operational departments directly or indirectly involved in the processes evaluated and/or identified areas for improvement.
ESSENTIAL FUNCTIONS:
Gathers detailed information on the implementation of operational processes related to claims and configurations to measure in a quantifiable way the quality of claims and assess the risk of error.
Identifies and evaluates quality assurance activities in all business processes to meet the Company's objectives, including, among others, sales, implementation, and configuration.
Analyzes the handling, processing, and/or payment of medical, dental, and life insurance claims by reviewing the policyholder's benefits, data entry, data integrity, business rules, provider contracts, service fees, and other applicable information sources to determine their appropriate handling.
Applies the standards established in MCS, the health industry, and/or regulatory agencies in the analysis to equally determine the compliance of the operational processes based on the established guidelines.
Uses the analyses performed to measure and determine the quality of the processes evaluated in the operations and/or business partners following the indicators established by MCS and/or the health industry.
Uses the analyses performed to identify areas of improvement, such as but not limited to assembly corrections in the systems used, modification and standardization of processes, retraining of personnel, application of payment rules, and/or business partner improvements, among others. Reports them to the relevant areas for corrective action and follows up to ensure their implementation.
Identifies incorrect payment of services through the analysis and refers them for recovery and/or adjustment.
Communicates to the immediate supervisor the results of the quality assessments, the identified areas of improvement, and the corrective actions taken with the departments and/or business partners.
Identifies trends in each of the evaluated processes and prepares monthly, quarterly, or annual reports using tools such as Excel, Word, or other applicable tools to refer them to their immediate supervisor and/or the management of the Unit.
Participates in developing, reviewing, and updating the work tools and the process policies and/or operational guides of the Unit through tools such as Excel, Word, or other applications to submit them for approval to their supervisor.
Participates in organizational projects as needed for achieving the goals assigned to the Unit.
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 and Experience: Bachelor's degree. At least two (2) years of experience in the industry. Analytical and statistical knowledge. Claim processing knowledge and familiarity with quality parameters in the industry.
\"Proven experience may be replaced by previously established requirements.\"
Certifications / Licenses: N/A.
Other: Proficient in Excel, Word, Access, and/or PowerPoint.
Languages:
Spanish – Basic (comprehensive, writing and verbal)
English – Basic (comprehensive, writing and verbal)
\"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.\"
Exempt
GENERAL DESCRIPTION:
Responsible for executing and reviewing quality controls for monitoring the operational processes established in the Unit to process claims and benefit configuration, seeking continuous improvement and quality. Proactively work on the referral and implementation of corrective actions with the operational departments directly or indirectly involved in the processes evaluated and/or identified areas for improvement.
ESSENTIAL FUNCTIONS:
Gathers detailed information on the implementation of operational processes related to claims and configurations to measure in a quantifiable way the quality of claims and assess the risk of error.
Identifies and evaluates quality assurance activities in all business processes to meet the Company's objectives, including, among others, sales, implementation, and configuration.
Analyzes the handling, processing, and/or payment of medical, dental, and life insurance claims by reviewing the policyholder's benefits, data entry, data integrity, business rules, provider contracts, service fees, and other applicable information sources to determine their appropriate handling.
Applies the standards established in MCS, the health industry, and/or regulatory agencies in the analysis to equally determine the compliance of the operational processes based on the established guidelines.
Uses the analyses performed to measure and determine the quality of the processes evaluated in the operations and/or business partners following the indicators established by MCS and/or the health industry.
Uses the analyses performed to identify areas of improvement, such as but not limited to assembly corrections in the systems used, modification and standardization of processes, retraining of personnel, application of payment rules, and/or business partner improvements, among others. Reports them to the relevant areas for corrective action and follows up to ensure their implementation.
Identifies incorrect payment of services through the analysis and refers them for recovery and/or adjustment.
Communicates to the immediate supervisor the results of the quality assessments, the identified areas of improvement, and the corrective actions taken with the departments and/or business partners.
Identifies trends in each of the evaluated processes and prepares monthly, quarterly, or annual reports using tools such as Excel, Word, or other applicable tools to refer them to their immediate supervisor and/or the management of the Unit.
Participates in developing, reviewing, and updating the work tools and the process policies and/or operational guides of the Unit through tools such as Excel, Word, or other applications to submit them for approval to their supervisor.
Participates in organizational projects as needed for achieving the goals assigned to the Unit.
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 and Experience: Bachelor's degree. At least two (2) years of experience in the industry. Analytical and statistical knowledge. Claim processing knowledge and familiarity with quality parameters in the industry.
\"Proven experience may be replaced by previously established requirements.\"
Certifications / Licenses: N/A.
Other: Proficient in Excel, Word, Access, and/or PowerPoint.
Languages:
Spanish – Basic (comprehensive, writing and verbal)
English – Basic (comprehensive, writing and verbal)
\"We are an Equal Employment Opportunity Employer and take Affirmative Action to recruit Protected Veterans and Individuals with Disabilities.\"
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