Job Description :

Responsible for optimizing the processes within the unit, leading efforts to streamline internal workflows, reduce inefficiencies, and ensure that our providers operations administration are aligned with regulatory requirements and organizational goals. Analyzes market trends and regulations to implement provide recommendations and implement effective solutions within the administration of providers.

ESSENTIAL FUNCTIONS:

• Researches and benchmarks competitor strategies to identify operational best practices and recommend improvements for efficiency and performance.
• Designs provider compensation models that support financial sustainability, drive quality outcomes, and enhance member satisfaction.
• Analyzes Medicare Advantage market trends and Centers for Medicare and Medicaid Services (CMS) data to identify operational impacts and support strategic planning.
• Measures provider performance using clinical, financial, and satisfaction metrics to inform strategic decisions and optimize compensation structures.
• Streamlines departmental workflows to eliminate inefficiencies, reduce administrative burden, and improve service delivery across teams.
• Leads cost containment initiatives by identifying operational cost drivers and implementing targeted process improvements.
• Enhances provider-facing systems and tools to ensure they are intuitive, effective, and aligned with provider workflows and needs.
• Promotes adoption of the Relisc Reporting platform through training, usability improvements, and integration into daily provider operations.
• Evaluates user feedback and performance data to implement enhancements to the Relisc platform that improve functionality and engagement.
• Develops and maintains Power BI dashboards to visualize key performance indicators (KPIs), operational metrics, and strategic insights.
• Collaborates with cross-functional teams to align operational strategies with organizational goals, compliance standards, and business priorities.
• 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.
  
   

MINIMUM QUALIFICATIONS:

Education and Experience: Bachelor's degree in Business Administration or related field. At least five (5) years of experience, which includes two (2) years of experience supervising personnel, performing similar tasks, such as data analysis and reporting, process evaluation, and provider administration, preferably within the Health Insurance Industry.

Other: Knowledge of Lean, Six Sigma, or other similar methodologies is highly valued. Experience in leading cross-functional teams and managing projects. Experience preparing and facilitating public presentations. Knowledge of Excel and/or Power BI for report preparation.

Languages: 

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.”