Medicare Member Care Concierge

Tecsa; Illinois; On-site; USD 46,000 - 58,000; Full time

Benefits offered by this job

Medical Insurance

Dental Insurance

Vision Insurance

Employer-Paid Life Insurance

Paid Maternal Leave

Paid Paternal Leave

401(K) match

Paid Time Off

Employee Assistance Program

Spouse Insurance

Job summary

Zing Health is seeking a CMSR-focused agent to serve as the primary contact for outbound and inbound member campaigns, ensuring timely resolutions and high satisfaction. You will navigate healthcare systems, answer questions, and coordinate scheduling and enrollment activities with care and accuracy.

Excellent communication and a strong knowledge of CMS guidelines are essential to thrive in this frontline role, which aims to improve CAHPS, retention and overall member experience.

Qualifications

• High school diploma or GED required.
• Minimum 2 years in customer service, preferably with 1 year in a call center.

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
• Provide service improvement recommendations to leadership based on experiences with the members i.e., ways member services can improve the overall Zing experience for the members.
• 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 i.e., 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.

Skills

Customer service

Call center experience

Communication skills

Problem solving

Education

High school/ GED

2+ years in customer service

Job description

Zing Health is seeking a CMSR-focused agent to serve as the primary contact for outbound and inbound member campaigns, ensuring timely resolutions and high satisfaction. You will navigate healthcare systems, answer questions, and coordinate scheduling and enrollment activities with care and accuracy.

Excellent communication and a strong knowledge of CMS guidelines are essential to thrive in this frontline role, which aims to improve CAHPS, retention and overall member experience.