Team Leader

Supports daily unit operations by completing document intake, evaluation, classification, and distribution processes. Provides guidance to technicians, resolves escalated issues, and acts as a liaison between internal and external teams to ensure efficient workflow and service delivery. Monitors workload, intake channels, and case aging to ensure timely processing and compliance with applicable regulatory requirements and organizational policies. Promotes quality and consistency in operations by supporting training initiatives, identifying performance and process improvement opportunities, and ensuring proper handling of confidential information. Regular Non-Exempt

GENERAL DESCRIPTION:

Supports daily unit operations by completing document intake, evaluation, classification, and distribution processes. Provides guidance to technicians, resolves escalated issues, and acts as a liaison between internal and external teams to ensure efficient workflow and service delivery. Monitors workload, intake channels, and case aging to ensure timely processing and compliance with applicable regulatory requirements and organizational policies. Promotes quality and consistency in operations by supporting training initiatives, identifying performance and process improvement opportunities, and ensuring proper handling of confidential information.

ESSENTIAL FUNCTIONS:

Supports daily unit operations, including document intake, evaluation, classification, and distribution. Provides guidance to technicians, resolving complex issues and serving as liaison between operational areas, internal teams, and external stakeholders. Oversees document management processes, acting as gatekeeper to ensure accurate receipt, classification, prioritization, and routing of requests, while identifying duplicates and inconsistencies. Monitors intake channels (e.g., fax, email, CRM) and workload to ensure timely processing, early identification of backlogs, and compliance with regulatory requirements. Ensures equitable distribution of work among technicians based on established quotas and priorities. Tracks case aging and service timelines to ensure compliance with Center for Medicaid and Medicare Services (CMS), Office of the Commissioner of Insurance (OIC), and applicable regulations, including Medicare Stars measures. Supports service cycle completion and coordinates with applicable teams (e.g., Call Center, Service Centers) to resolve member or provider requests. Provides training and mentorship to new and existing employees, identifying performance gaps and reporting progress to management. Evaluates team productivity and efficiency in collaboration with supervisors, ensuring quality and compliance standards are met. Maintains control and confidentiality of Protected Health Information (PHI) and unit documentation in accordance with established policies. Identifies process improvement opportunities and recommends solutions to enhance efficiency, quality, and compliance. 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: Associate’s Degree or a minimum of sixty (60) approved college credits in Health Administration, Business Administration, or a related field. At least two (2) years of experience in healthcare operations, preferably in Grievances & Appeals, document intake, or receipt and distribution processes. “Proven experience may be replaced by previously established requirements.” Certifications / Licenses: N/A Other: N/A Languages: Spanish – Basic (comprehensive, writing and verbal) English – Intermediate (comprehensive, writing and verbal) We are an Equal Employment Opportunity Employer and take affirmative Action to recruit Protected Veterans and Individuals with Disabilities. #J-18808-Ljbffr MCS Puerto Rico