Member Service Representative

• 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.

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Concierge Member Service Representative