Quality Engagement Specialist

Company Overview

Zing Health is a technology-driven insurance provider focused on enhancing Medicare Advantage for individuals aged 65 and older. The company emphasizes a community-based strategy that considers social determinants of health to promote wellness within communities. Zing Health centers healthcare around both physicians and members, offering tailored plans, supportive facilities, and dedicated care teams to ease the transition and improve healthcare experiences.

Role Summary

The Quality Engagement Specialist plays a vital role in reaching out to members through both inbound and outbound communications, aiming to enhance health outcomes by closing care gaps, promoting medication adherence, increasing compliance with preventive care, and improving overall member satisfaction. This position requires collaboration with healthcare providers, pharmacies, and internal teams to support Medicare Stars, HEDIS, CAHPS, and quality improvement programs while providing outstanding customer service.

Key Responsibilities

• Initiate and receive calls addressing quality initiatives related to preventive screenings, annual wellness visits, medication adherence, CAHPS, care gap closures, and follow-ups after emergency room visits.
• Educate members on the significance of preventive healthcare and the resources offered by their health plans.
• Assist members in scheduling healthcare appointments, acquiring screenings, navigating medical services, and referring them to clinical programs when needed.
• Contribute to organizational objectives linked to Medicare Stars, HEDIS, CAHPS, and quality metrics.
• Precisely record all outreach efforts and member interactions within relevant systems.
• Identify obstacles members face in completing healthcare activities and offer suitable solutions or referrals.
• Escalate issues such as member concerns, complaints, or service problems to appropriate departments as necessary.
• Maintain strict adherence to CMS rules, Medicare guidelines, HIPAA standards, and company policies.
• Comply with established procedures for call handling, documentation, and quality assurance.
• Participate actively in team meetings, training, and departmental projects.
• Achieve targeted metrics for productivity, quality, attendance, and performance.
• Protect member confidentiality and data security at all times.
• Communicate member feedback, call trends, and suggestions for process improvement to leadership.
• Collaborate effectively with Quality, Care Management, Member Services, Pharmacy, Network, and Operations teams.
• Support various special projects and outreach efforts as assigned.

Additional Responsibilities

• Maintain performance metrics, including call handling, caller satisfaction, quality, and STAR score objectives, aiming for an average audit score of 95% on a rolling basis.
• Provide timely and proactive feedback to leadership about any business execution challenges.

Qualifications

• High school diploma or equivalent.
• At least 3 years of customer service experience, with minimum 2 years in a call center environment.
• Minimum 2 years of experience in healthcare or health insurance sectors.
• Strong verbal and interpersonal communication skills.
• Proficient in Microsoft Office applications and customer relationship management tools.

Preferred Qualifications

• Over 1 year of experience with Medicare or Medicare Advantage programs.
• Background as a Certified Nursing Assistant (CNA), Certified Medical Assistant (CMA), or Patient Advocate.
• Experience supporting Medicare Stars, HEDIS, CAHPS, medication adherence, or population health initiatives.
• Bilingual proficiency in English and Spanish.
• Familiarity with outbound healthcare outreach campaigns.

Member Impact

The Member Services team serves as the primary contact point for members, addressing inquiries and resolving issues with empathy and effectiveness. Exceptional service enhances member trust, loyalty, and engagement with preventive and supplemental benefits, positively influencing retention rates and satisfaction scores.

Benefits

• Competitive market-based salary.
• Medical, dental, and vision coverage.
• Employer-paid life insurance.
• Paid maternity and paternity leave.
• 401(k) plan with up to 4% employer match.
• Paid time off.
• Employee assistance programs.
• Additional optional benefits including spouse insurance, pet insurance, critical illness coverage, and identity protection.

Equal Opportunity Statement

Zing Health is dedicated to equal employment opportunity, making decisions free from discrimination based on race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected status. The company fosters a diverse and inclusive workplace culture promoting fairness and opportunities for growth for all employees and applicants.