Medicare Member Engagement & Care Gap Specialist

Tecsa

Illinois

On-site

USD 48,000 - 70,000

Full time

4 days ago

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Benefits offered by this job

Competitive salary based on market

Medical, Dental, and Vision

Employer-Paid Life Insurance

Paid Maternal Leave

Paid Paternal Leave

401(K) match up to 4%

Paid-Time-Off

Employee Assistance Programs

Supplemental benefits (spouse, pet, ID

Job summary

Zing Health is seeking a Quality Engagement Specialist to engage members through inbound/outbound outreach, improving health outcomes and adherence, while supporting Medicare Stars and related quality initiatives. The role collaborates with providers, pharmacies, and internal teams to educate, motivate, and assist members in completing healthcare activities.

This position emphasizes customer service excellence, adherence to CMS regulations, and confidentiality.

Qualifications

High school diploma or equivalent required.
3+ years in customer service, preferably call center environment.
2+ years in healthcare or health insurance.
Strong communication and interpersonal skills.
Proficiency with Microsoft Office and CRM systems.

Responsibilities

Conduct outbound and inbound calls to members regarding quality and Stars initiatives, preventive screenings, and care gap closure.
Educate members on preventive healthcare and plan resources.
Assist members with scheduling appointments and navigating services; refer to clinical services when needed.
Support Medicare Stars, HEDIS, CAHPS, and quality measures.
Document all outreach activities and member interactions in systems.
Identify barriers to completing activities and provide solutions or referrals.
Escalate member concerns to appropriate departments when necessary.
Maintain CMS, Medicare guidelines, and HIPAA compliance.