Quality Engagement Specialist

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. The company aims to return the physician and the member to the center of the health care equation, offering members individualized assistance, personalized plans, access to specialized facilities, and a dedicated care team.

About the role

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.

Responsibilities

• Conduct outbound and inbound calls to members regarding:
  • Quality and Stars-related initiatives, including preventive screenings, annual wellness visits, medication adherence, CAHPS improvement activities, and care gap closure opportunities
  • 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; 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
• Maintain target performance metrics, including call handling, caller satisfaction, quality, and STAR score initiatives, 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

• 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 Assistant (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

Benefits

• A competitive salary based on the market
• Medical, Dental, and Vision coverage
• 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, including Spouse Insurance, Pet Insurance, Critical Illness coverage, and ID Protection