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Manager

• Conducting health risk assessments
• Coordination of care
• Care management for MAPD, C-SNP, and D-SNP members
• Follows the patient through various transitions of care to ensure that any gaps in treatment plans are identified and remedied.
• Promoting efficient health care delivery.
• Participates in assessment activities to develop individualized care plans in coordination with the patient, family, and providers.
• Serves as a member advocate and resource, and provides critical information and recommendations to the rest of the care team.
• Maintains strong knowledge of Case management, community resources, and plan benefits to promote improved member experience and health outcomes.
• Works collaboratively with the member (and caregivers), primary care physicians, specialists, and other care providers to ensure member compliance and adherence to the medical plan of care.
• Assists the Health Services Team in implementing best practices for chronic care and disease management.
• Provides member education to assist with self-management and encourages members to make healthy lifestyle changes.

Integrated Care Manager, RN

Financial Planning and Analysis

• Oversee general ledger, accounts payable/receivable, payroll, and month-end/year-end closing processes
• Manage recording and reporting actuals for expenses (invoices, vendor setup, GL, etc.)
• Maintain weekly cash forecasts
• Coordinate with external auditors and ensure timely completion of audits and tax filings
• Conduct financial reconciliation and reporting of accounts for all company’s entities
• Supervise and mentor accounting staff, providing training, feedback, and performance evaluations
• Coordinate with outside consultants on financial, tax and other statutory State filings
• Identify opportunities for efficiency, automation, and enhanced financial reporting capabilities
• Partner with operations, HR, and executive leadership on financial planning and business strategy
• Assist, develop and execute to Model Audit Rule compliance

Finance Manager

Actuary

• Assist in the development of Incurred But Not Reported (IBNR) reserves for monthly close processes
• Support monthly financial reconciliation for Value-Based Providers
• Contribute to the development and submission of Medicare Advantage bids
• Assist with quarterly forecasting and trend analysis
• Perform financial analysis and build actuarial models
• Develop actionable insights and recommendations based on data analysis

Actuarial Analyst

Risk

• Build and automate reports using Python, SQL, Excel, etc.
• Analyze large and small datasets: join, transform, engineer features, and extract insights.
• Performs research and deep-dive analysis of complex healthcare claims data, CMS return files, and financial cost, revenue, and vendor data.
• Use the CMS risk adjustment model to support revenue accruals.
• Optimize Medicare Advantage audit outcomes using statistical techniques.
• Create tools and dashboards that improve operational efficiency.

Risk Adjustment Analyst

• Manage physician contracting and network development for an assigned region
• Develop and maintain cooperative working relationships with the provider community
• Educate, train, research issues, and identify trends
• Evaluate providers to ensure contractual and financial requirements are adhered to
• Contracts and negotiates with Hospital, FQHCs, Physicians and Ancillary providers for all product lines
• Conduct Provider Orientations and ongoing education to Network Providers
• Understand and explain fee-for-service and risk contracts
• Respond to provider’s contract requests and inquiries
• Analyze network gaps and identify providers to contract
• Review and amend provider’s contracts when necessary
• Evaluate contracted network to ensure functionality
• Research and develop relationships with non-contracted providers
• Collect credentialing and required documents for newly contracted providers
• Perform special projects as assigned

Provider Contracting Manager

QA Engineer

• Evaluate current policies and procedures against CMS/NCQA requirements; identify gaps and recommend improvements.
• Ensure system enhancements and implementations meet business and regulatory needs.
• Develop and deliver training on new CMS/NCQA requirements; administer exams as needed.
• Conduct internal and delegated audits; monitor pharmacy operations and recommend corrective actions.
• Lead recovery efforts for COB, ESRD, Hospice, PDEs, LICs, P2P, and related processes.
• Analyze claims and utilization data to ensure quality controls are in place.
• Reconcile vendor invoices and resolve member/provider issues from Salesforce cases.
• Support PDE management and error resolution processes.
• Oversee FIR and COB backend reconciliation activities.
• Manage monthly quality checks for marketing materials (print and web).
• Perform monthly audits and exams across pharmacy units.
• Present recommendations to improve system and process efficiency.
• Conduct monthly internal audits and exams.
• Coordinate audits of delegated entities and vendors.
• Support CMS Financial, Operational, and NCQA audits.
• Maintain audit samples and monitor performance metrics.
• Manage annual updates to policies, procedures, and training logs.
• Lead execution of the Pharmacy Internal Audit Plan (e.g., FIR/Nx Rejects, PDE Monitoring, MTM, Formulary Administration, Claims Processing).
• Maintain and execute Corrective Action Plans and Compliance Issues Logs.
• Facilitate monthly internal compliance meetings.

Pharmacy Quality Assurance Analyst

Customer Support

• Support day-to-day broker inquiries, via email and telephonically, to support broker satisfaction to help Zing become known as the easiest plan to do business with from a broker perspective.
• Collaborate within the Broker Support team to support the long-term strategy and vision for the broker support function, including the right tools/processes needed, communication trends, specialization and resolution aids, and best practices.
• Partner closely with Zing Partner Sales groups, which drive broker sales to ensure holistic synergies exist between those Growth functions and expectations can be delivered on with Zing’s broker partners.