Quality Engagement Specialist

Company Overview

Zing Health is a tech-enabled insurance company making Medicare Advantage the best it can be for those 65-and-over. Zing Health has a community-based approach that recognizes the importance of the social determinants of health in keeping individuals and communities healthy. Zing Health aims to return the physician and the member to the center of the health care equation. Members receive individualized assistance to make their transition to Zing Health as easy as possible. Zing Health offers members the ability to personalize their plans, access to facilities designed to help them better meet their healthcare needs and a dedicated care team. For more information on Zing Health, visit www.myzinghealth.com.

Job Summary: 

The Quality Engagement Specialist is responsible for engaging members through inbound and outbound outreach campaigns designed to improve health outcomes, close care gaps, support medication adherence, increase preventive care compliance, and enhance the overall member experience. This role partners closely with members, providers, pharmacies, and internal departments to support Medicare Stars, HEDIS, CAHPS, and quality improvement initiatives while delivering exceptional customer service.

The Quality Engagement Specialist serves as a trusted advocate for members by educating, motivating, and assisting them in completing healthcare activities that contribute to improved health outcomes and satisfaction.

Key Responsibilities:

• Conduct outbound and inbound calls to members regarding (1) quality and Stars-related initiatives, including preventive screenings, annual wellness visits, medication adherence, CAHPS improvement activities, and care gap closure opportunities and (2) post emergency room visit needs. 
• Educate members on the importance of preventive healthcare and available health plan resources.
• Assist members with scheduling appointments, obtaining screenings, and navigating healthcare services and refer members to clinical services where appropriate.
• Support organizational goals related to Medicare Stars, HEDIS, CAHPS, and quality measures.
• Accurately document all outreach activities and member interactions in applicable systems.
• Identify barriers preventing members from completing healthcare activities and provide appropriate solutions or referrals.
• Escalate member concerns, grievances, or service issues to the appropriate departments when necessary.
• Maintain compliance with CMS regulations, Medicare guidelines, HIPAA requirements, and company policies.
• Follow established call handling procedures, quality standards, and documentation requirements.
• Participate in team meetings, training sessions, and departmental initiatives.
• Meet established productivity, quality, attendance, and performance metrics.
• Maintain confidentiality and security of member information at all times.
• Share member feedback, call trends, and process improvement recommendations with leadership.
• Work collaboratively with Quality, Care Management, Member Services, Pharmacy, Network, and Operations teams.
• Support special projects and outreach campaigns as assigned.

Additional Responsibilities:

• 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 leadership team when challenges with business execution arise.

Required Qualifications:

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

Preferred Qualifications:

• 1+ years in Medicare / Medicare Advantage
• Certified Nursing Assistant (CNA), Certified Medical Assist (CMA) or Patient Advocate Experience
• Proficiency supporting Stars, HEDIS, CAHPS, medication adherence, or population health initiatives
• Bilingual English/Spanish
• Experience with outbound healthcare outreach campaigns

Member-Centric Impact Statement

Member Services is the frontline of member interaction, resolving concerns, answering questions, and providing assistance with empathy and efficiency. Exceptional customer service fosters member trust and satisfaction, encourages loyalty and retention, and streamlines processes to boost overall organizational productivity. Measurable impact includes improved retention rates, higher CAHPS and NPS scores, reduced voluntary disenrollment, and increased member engagement with preventive and supplemental benefits.

Member Success drives satisfaction and retention quality engagement by conducting proactive outreach, guiding members through benefits, coordinating issue resolution across departments, and ensuring smooth transitions of care. The team focuses on members with care gaps and issues and medication adherence concerns and addresses their barriers to care.

Zing Health offers the following benefits:

•  A competitive salary based on the 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
•  Several supplemental benefits are available, including, but not limited to, Spouse Insurance, Pet Insurance, Critical Illness coverage, ID Protection, etc.

Zing Health is committed to being an Equal Opportunity Employer. This means the company ensures all employment decisions, including hiring, promotion, compensation, and benefits, are made without regard to race, color, religion, sex, national origin, age, disability, veteran status, sexual orientation, gender identity, or any other legally protected characteristic. Zing Health strives to create a diverse, inclusive, and respectful workplace, providing equal access and opportunities for all employees and applicants. The organization actively promotes a culture of fairness and non-discrimination, supporting the personal and professional growth of every team member