Concierge Member Service Representative (CMSR)

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 healthcare 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.

SUMMARY

The CMSR acts as the primary representative for member outbound campaigns that are aligned with organizational objectives. Further, the CMSR offers end-to-end solutions for members who need assistance on a more personal and integrated level for both inbound and outbound calls.

JOB 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 escalate to leadership for ongoing internal process improvement.
• 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.

QUALIFICATIONS AND REQUIREMENTS:

EDUCATION:

• High school/ GED
• 2+ years in customer service, preferably with 1 year within a call center environment

PREFERRED:

• 2+ years in health insurance
• 1+ years in Medicare

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