Concierge Member Service Representative

Jobtailor; Illinois; Hybrid; USD 42,000 - 64,000; Full time

Job summary

Jobtailor is seeking a Customer Service Specialist in Illinois to be the first line of contact for escalated service issues. You will resolve inquiries within service levels, perform data entry, and navigate Zing Health systems to deliver accurate, timely information.

Role requires 2+ years in customer service and health insurance, with a preference for Medicare experience. Expect collaborative work with multiple departments to improve member experience and adherence to CMS guidelines.

Qualifications

• 2+ years in customer service, preferably with 1 year within a call center environment.
• 2+ years in health insurance (PREFERRED)
• 1+ years in Medicare (PREFERRED)

Responsibilities

• Provide service resolutions within targeted service levels as first line of contact.
• Aim to provide first call resolution for all inbound inquiries.
• Interact with members, providers, and callers via phone, email, and web services while entering data for all activity.
• Navigate Zing Health systems and partnering systems applicable to the business.
• Provide timely and accurate information to callers, while proactively partnering with team members and other departments to facilitate effective resolutions.
• Understand CMS guidelines for managing membership, provider partnerships, enrollment/disenrollment, and claims.
• Advise callers of onboarding process, coverage details, benefits, etc.
• Identify opportunity trends by acknowledging consistent questions or challenges and elevate to leadership for process improvement.
• Provide service improvement recommendations to leadership based on member experiences.
• Maintain comprehensive knowledge of Zing Health policies and procedures across departments.
• Assist members with scheduling appointments with primary care physicians, specialists, or value-based providers.
• Coordinate end-to-end appointment execution including scheduling and follow-ups.
• Ensure in-network providers are available for scheduling and add providers as needed.
• Conduct outbound call campaigns while meeting performance expectations and member needs.
• Handle performance expectations aligned with CAHPS, satisfaction, retention, quality, and stars.
• Provide ongoing feedback to leadership when challenges arise.

Skills

Customer service

Call center experience

Health insurance

CMS guidelines

Data entry

Education

High school/GED

Job description

Responsibilities

• Provide service resolutions within targeted service levels and serve as first line of contact for escalated service issues.
• Aim to provide first call resolution for all inbound inquiries.
• Interact with members, providers, and other caller types via phone, email, web services, etc. while performing data entry functions for all activity.
• Effectively navigate and comprehend all elements of Zing Health systems, and partnering systems, that are applicable to the business.
• Provide timely and accurate information to callers, while proactively partnering with team members and other departments, as necessary, to facilitate effective, compliant, and quality resolutions.
• Understand CMS guidelines for managing business areas including, but not limited to, membership, provider partnerships, marketing, enrollment/disenrollment, and claims.
• Advise callers of their onboarding process, coverage details, benefits, etc.
• Identify opportunity trends by acknowledging consistent questions or challenges raised by the team, and proactively elevate to leadership for ongoing internal process improvement.
• Provide service improvement recommendations to leadership based on experiences with the members – ways member services can improve the overall Zing experience.
• Maintain a comprehensive knowledge of all Zing Health policy and procedures, products and services including departmental processes of Operations, Sales, Network, Quality, Customer Relations, etc.
• Assist members with scheduling appointments with primary care physicians, specialists, or value‑based providers via scheduling processes and tools.
• Coordinate end‑to‑end appointment execution – scheduling, ride setup, pharmacy and prescription preferences, follow‑up appointments, etc.
• Ensure in‑network providers are available for scheduling by Member Services and add/activate providers who need to be added to any applicable platforms.
• Conduct monthly/ongoing outbound call campaigns while adhering to call performance expectations as well as individual member needs including but not limited to health risk assessment completion, annual wellness visit scheduling, etc.
• Handle situational performance expectations aligned with corporate objectives related to CAHPS, member satisfaction, member retention, quality and stars, etc.
• Maintain target performance metrics, that may include, but are not limited to, call handling, caller satisfaction, quality, STAR score initiatives, etc., while maintaining an average audit score of 95% on a rolling basis.
• Provide ongoing, and proactive feedback to the leadership team when challenges with business execution arise.

Requirements

• High school/ GED
• 2+ years in customer service, preferably with 1 year within a call center environment
• 2+ years in health insurance (PREFERRED)
• 1+ years in Medicare (PREFERRED)