Description 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 DESCRIPTION: The Grievance and Appeals Specialist position is responsible for reviewing and resolving members' and/or providers' complaints and communicating resolution to members or authorized representatives and/or providers in accordance with the standards and requirements established by the Centers for Medicare and Medicaid Services (CMS). The Grievance and Appeals Specialist has frequent external contact with members and health care providers and interacts with and plays a key role in collaborating with internal contacts in Member Engagement, Provider Services, Pharmacy, Utilization Management, and other resources to identify factors necessary for the optimal resolution of complaints. ESSENTIAL FUNCTIONS: - Be able to process both appeals and grievances. - Have a strong Medicare Appeals processing background. - Logging, tracking, and ensuring completion of all appeals, direct member reimbursements, and grievance cases in compliance with CMS standards. - Manage tracking database to ensure the integrity of data and that all assigned cases are captured and maintained appropriately. - Prepare documentation and transmit appeals of clinical denials to the appropriate professional for review and tracking review completion to ensure final closure of the associated case. - Participate in all aspects of the direct member reimbursement, grievance & appeal process, specifically intake, triage, coordination, and documentation. - Research, investigate, and resolve administrative aspects of appeals and/or grievances from Zing members and related outside agencies utilizing systems, clinical assessment skills, knowledge, and approved “Decision Support Tools” in the decision-making process regarding health care services and care provided to members. - Assures the accuracy, timeliness, and appropriateness of all grievances and appeals according to state and federal, and Zing guidelines. - Collaborate with internal departments as necessary (Customer Service, Provider Services, Quality, Claims, Utilization Management, and others to ensure the timely resolution of all grievances and appeals. - Document the results of complaints and appeals and dispositions at all levels, including notification to providers and members. - Prepare and determine the appropriate language for letters and prepare responses for all appeals and grievances. - Assists with interdepartmental issues to help coordinate problem-solving in an efficient and timely manner. - Assist the Manager of Grievance and Appeals in establishing and maintaining policies and procedures, compliance reporting, and training material. - Manage workload volume, ensuring accuracy and compliance with scheduled deadlines. - Perform other related duties as assigned. Requirements QUALIFICATIONS AND REQUIREMENTS: Required Qualifications - High school diploma or GED with at least two years of college or equivalent experience - Strong communication skills both oral and written - Strong organizational skills, consistent attention to detail and independent problem-solving skills - Minimum of two (2) years of experience in a Managed Care (Health Plan) environment performing appeals reviews/investigation or data analysis. - Knowledgeable of various operational areas such as customer service, provider service, claims processing, utilization management, pharmacy and dental in a managed care setting. - Ability to perform multiple tasks simultaneously, work under pressure and meet critical deadlines. - Must possess a high degree of professionalism and business ethics. - Knowledge of medical terminology, insurance terminology and benefit plan coverage and exclusions Preferred Qualifications - Familiarity with CMS claims denials and appeals processing, rules, regulations and accreditation standards and requirements. - Advanced knowledge of computer systems, such as Microsoft Word, Excel, and Outlook.

Recognized on the Inc. 5000 fastest growing companies in the US, Peloton is one of the largest and fastest growing professional services firms specializing in Integrated Cloud Solutions for Enterprise Resource Planning, Enterprise Performance Management, Supply Chain Management, Human Capital Management and Big Data and Analytics. Peloton has the vision and connected capabilities to help CFOs, CIOs and business leaders to envision, implement and realize the benefits of digital transformation. Companies that are equipped with the right information, have the know-how, and the enabling technology to consistently leverage analytics will gain a competitive advantage. Our people are recognized as some of the best minds and most committed people in the industry. We believe in quality. We appreciate creativity. We recognize individual contributions, and we place trust in our team members. And…we love what we do. Peloton provides Advisory, Consulting, and Managed services with deep functional and technical expertise specializing in serving clients in the Retail, Manufacturing, Life Sciences, High Tech, Professional Services, and Financial Services industries. Our business and technology professionals provide a unique perspective, proven experience, with an innovative and collaborative approach to achieve results for clients. Our business and technology professionals provide a unique perspective, proven experience, with an innovative and collaborative approach to achieve results for clients. If you are interested in being a part of our high performing and growing organization – and have strong business and/or technical expertise; especially as related to Oracle Cloud Applications, you may be a good fit for our team. Peloton has a unique opportunity for an experienced Service Delivery Manager to play a hands-on role as part of our Application Managed Services team. As an Application Managed Services SDM, you will be responsible for: - Oversee the delivery of Oracle support to clients, ensuring they meet agreed-upon service levels (SLAs) and quality standards. - Manage day-to-day operations of the support delivery team, including monitoring performance. - Manage clients with diverse portfolios of Oracle products. - Build and maintain strong relationships with clients, acting as the primary point of contact for service-related issues, escalations and internal coordination. - Develop and implement service delivery strategies, focusing on continuous improvement and client satisfaction. - Lead the resolution of escalated service incidents and issues, coordinating with technical teams to ensure timely resolution. - Ensure that all services are delivered in accordance with contractual agreements and industry best practices. - Collaborate with clients and internal teams to facilitate contract renewals, ensuring continued service alignment with client needs, identifying opportunities for contract expansion, and ensuring that services provided align with evolving business goals. - Track and report on key performance indicators (KPIs), preparing regular performance reports for clients and internal stakeholders. - Drive service improvement initiatives and identify opportunities for cost reduction or service optimization. - Work closely with project managers to ensure smooth transitions for new projects, services and enhancements. - Ensure compliance with internal policies, standards, and security protocols in service delivery. - Assist in the development of proposals and service contracts for prospective clients. - Mentor and support the service support team, providing coaching and development opportunities. - Participate in client meetings, to assess service performance and plan improvements. Required Experience & Skills: - Bachelor’s degree in business management, Information Technology, or related field. - Proven experience as a Service Delivery Manager, Program Manager or in a similar Business Support services management role. - Industry experience is nice to have. - Excellent communication and interpersonal skills. - Strong problem-solving skills and ability to manage complex service delivery issues. - Experience in managing client relationships and customer satisfaction. - Experience managing clients with diverse Oracle cloud product portfolios. - Experience in tracking and managing budget, resources, and planning activities to drive an elevated strategic client experience. - Ability to conduct regular status meetings, provide updates, and serve as the primary point of scalations. - Familiarity with service management tools and software. - Ability to work under pressure and manage multiple priorities. - Excellent analytical and critical thinking skills. - Knowledge of ITIL (Information Technology Infrastructure Library) and other service management frameworks is nice to have - Proven ability to work remotely and independently in support of clients and team members. - Fit with Peloton culture and company values: teamwork, innovation, integrity, service, “can-do” attitude, and speaking your ideas. - Strong written and verbal communication skills in English. Peloton Group is committed to creating a diverse environment and is proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. #LI-AP2 #LI-REMOTE

Hours: Must be able to Work between 8:00 a.m.-5:30 p.m. Monday-Friday Role Summary Reporting to the Clinical Quality Supervisor, the Clinical Quality Sustainment Coach (QSC) is responsible for performing quality reviews of clinical cases and call recordings within Cigna operational systems. This role delivers direct feedback and coaching to operational front-line staff based on review outcomes to drive quality improvement, consistency, and improved member outcomes. The QSC supports quality analysis and contributes to quality improvement initiatives across Care Solutions, with oversight from leadership. Responsibilities - Champion Cigna’s Consumer Health Engagement Cultural Beliefs: Customer Strong, Me to We, Own It!, Be Bold, Listen to Advocate, Think It Through. - Serve as a subject matter expert (SME) for assigned clinical and operational areas. - Conduct quality reviews to ensure documentation accuracy and adherence to established quality standards. - Deliver timely, constructive coaching to front-line staff, highlighting successes and opportunities for improvement. - Ensure quality reviews are accurately tracked and documented within designated quality review tools. - Explain and reinforce foundational quality principles and expectations. - Review quality performance data with front-line staff and operational leadership on a monthly basis. - Identify, interpret, and explain department quality metrics. - Exchange quality practices and procedural guidance with matrix partners. - Develop, analyze, and distribute case and call quality review reports. - Collaborate with Readiness & Support (R&S) team members to address trends and improvement opportunities. - Partner with Readiness Team Learning Facilitators to support new hire development and close identified knowledge gaps. - Identify adherence gaps, discrepancies, and error trends; escalate findings and recommendations to operational leadership. - Participate in departmental projects, initiatives, and stretch assignments as assigned. Qualifications - Active, unrestricted Registered Nurse (RN) license in state of residency - Minimum of three (3) years of nursing experience. - Clinical experience in Case Management - Strong clinical expertise with an understanding of operational workflows, SOPs, policies, and procedures relevant to the assigned area. - Proficiency with Microsoft Word, Excel, SharePoint, WebEx, and Outlook. - Excellent verbal and written communication skills. - Demonstrated coaching skills with the ability to provide positive, constructive feedback. - Ability to recognize and acknowledge individual and team successes. - High emotional intelligence with the ability to quickly build professional, trusting relationships. - Strong analytical skills with the ability to identify trends, action steps, and improvement opportunities. - Ability to assess quality both quantitatively and qualitatively. - Detail-oriented with strong time management, organization, and multitasking skills. - Comfortable raising questions, ideas, and recommendations across all levels of the organization. - Ability to work independently and collaboratively as part of a team. - Acts as a positive role model aligned with Cigna values. Preferred Qualifications - Experience with clinical and operational systems such as Knowledge Exchange, CCV, OneView, ICMS, TruCare, Verint, or similar platforms. - Client audit experience. - Prior experience as a team lead, subject matter expert, or preceptor. If you will be working at home occasionally or permanently, the internet connection must be obtained through a cable broadband or fiber optic internet service provider with speeds of at least 10Mbps download/5Mbps upload. For this position, we anticipate offering an annual salary of 77,300 - 128,800 USD / yearly, depending on relevant factors, including experience and geographic location. This role is also anticipated to be eligible to participate in an annual bonus plan. At The Cigna Group, you’ll enjoy a comprehensive range of benefits, with a focus on supporting your whole health. Starting on day one of your employment, you’ll be offered several health-related benefits including medical, vision, dental, and well-being and behavioral health programs. We also offer 401(k), company paid life insurance, tuition reimbursement, a minimum of 18 days of paid time off per year and paid holidays. For more details on our employee benefits programs, click here. About Evernorth Health Services Evernorth Health Services, a division of The Cigna Group, creates pharmacy, care and benefit solutions to improve health and increase vitality. We relentlessly innovate to make the prediction, prevention and treatment of illness and disease more accessible to millions of people. Join us in driving growth and improving lives. Qualified applicants will be considered without regard to race, color, age, disability, sex, childbirth (including pregnancy) or related medical conditions including but not limited to lactation, sexual orientation, gender identity or expression, veteran or military status, religion, national origin, ancestry, marital or familial status, genetic information, status with regard to public assistance, citizenship status or any other characteristic protected by applicable equal employment opportunity laws. If you need a reasonable accommodation to complete the online application process, please email seeyourself@thecignagroup.com for assistance. Please note that this email inbox is dedicated to accommodation requests only and cannot provide application updates or accept resumes. The Cigna Group has a tobacco-free policy and reserves the right not to hire tobacco/nicotine users in states where that is legally permissible. Candidates in such states who use tobacco/nicotine will not be considered for employment unless they enter a qualifying smoking cessation program prior to the start of their employment. These states include: Alabama, Alaska, Arizona, Arkansas, Delaware, Florida, Georgia, Hawaii, Idaho, Iowa, Kansas, Maryland, Massachusetts, Michigan, Nebraska, Ohio, Pennsylvania, Texas, Utah, Vermont, and Washington State. Qualified applicants with criminal histories will be considered for employment in a manner consistent with all federal, state and local ordinances.

Cardinal Health Sonexus™ Access and Patient Support helps specialty pharmaceutical manufacturers remove barriers to care so that patients can access, afford and remain on the therapy they need for a better quality of life. Our diverse expertise in pharma, payer and hub services allows us to deliver best-in-class solutions—driving brand and patient markers of success. We’re continuously integrating advanced and emerging technologies to streamline patient onboarding, qualification and adherence. Our non-commercial specialty pharmacy is centralized at our custom-designed facility outside of Dallas, Texas, empowering manufacturers to rethink the reach and impact of their products. Together, we can get life-changing therapies to patients who need them—faster. What Individualized Care contributes to Cardinal Health Clinical Operations is responsible for providing clinical specialties support and expertise in the areas of advice and consulting, research and patient care to internal business units and external customers. Individualized Care provides care that is planned to meet the particular needs of an individual patient. Job Summary The Nurse, Individualized Care promotes high-quality patient care and treatment through patient education. The Nurse Care Manager (NCM) will play a critical role in supporting identified cohorts of oncology patients across their continuum of care. This role coordinates comprehensive care, proactively monitors patient progress, and delivers continuous, personalized support between provider visits within a virtual environment. Focusing on management of side effects where applicable and improving the quality of care for cancer patients, the NCM drives patient engagement in their health and wellness through remote care planning and management. Utilizing telehealth platforms, the NCM may also facilitate transitions from acute care to home, ensuring continuity of care and optimal resource utilization through close collaboration with the interdisciplinary oncology team. Responsibilities -Collaborate with health care staff responsible for patient care to develop, implement, monitor and evaluate appropriate clinical care or other services to meet the needs of patients and coordinate all activities related to care management. -Ensure that areas of responsibility are operating in compliance, including documentation and records with all federal, state, and regulatory agencies. -Document all encounters and activities in the designated system accurately and in a timely manner -Participate in interdisciplinary case conferences and team huddles to ensure coordinated care as needed -With the oncology care team and internal care management team, identify patients to be case managed, assess patient’s care requirements, modify or coordinate modification of patient care and intervene, as necessary -Participate in the development and review of clinical pathway trends and share with appropriate service and management teams -Assist in quality improvement activities by identifying trends, barriers, and opportunities to improve program outcomes -Attend meetings, seminars, and conferences as appropriate -Principal and Chronic Care Management -Telephonically manage patient care, through the following methods: - Review of the patient’s medical, functional, and psychosocial needs - Medication reconciliation with review for adherence - Reinforce disease self-management education and symptom management - Communicate provider instructions and advice, and provide patient education materials - Referral to and coordination with community service organizations and make and/or specialist appointments and schedule other tests, treatments or procedures as needed - Facilitating patient follow-up visits with acute or chronic needs - Documents all concerns and follow-up and escalates to the onsite Clinical Team, or oncology provider when appropriate -Provide coaching and health promotion to encourage self-management and adherence to care plans -Collaborate with onsite clinical staff to order supplies for patients as needed (e.g., blood pressure machines, remote patient monitoring medical supplies) -Track and report on member progress, escalating complex cases to provider, the onsite clinical team or program leadership as needed -Transitional Care Management: - Attempt outreach to TCM members on the caseload via phone call as needed to support onsite TCM programs. - Assist with discharge planning: assess needs; help coordinate medication reconciliation; schedule TCM (Post -Acute) face-to- face visit with provider - Triage patient needs and identify necessary plan of action within such as scheduling an appointment, triaging for a provider or directing the patient to the ER, etc. as needed. - Bridge gaps between the onsite clinical team and the community, and ensuring patients fully understand their discharge instructions and follow-up care -Meets regularly with management team to discuss feedback from call monitoring and quality reviews. Discusses progress on productivity and quality goals. -Responsible for maintaining HIPAA guidelines Qualifications - Registered Nurse with a current, unrestricted California license required - 5 years’ experience-hospital or clinical, involving patients with complex chronic disease states preferred - Care Management experience is strongly preferred - Oncology patient experience a plus - Strong working knowledge and basic medical management of chronic disease states - Experience with Microsoft Office products - Basic computer skills including previous work with an electronic health record (EHR) and Excel spreadsheets - Superior communication skills to include verbal and written - Must be able to work collaboratively; team focused - Excellent organizational skills - Bilingual skills a plus What is expected of you and others at this level -Apply working knowledge in the application of concepts, principles and technical capabilities to perform varied tasks -Work on projects of moderate scope and complexity -Identify possible solutions to a variety of technical problems and take action to resolve -Apply judgment within defined parameters · Receive general guidance and may receive more detailed instruction on new projects -Work reviewed for sound reasoning and accuracy -Ability to collaborate effectively with the onsite clinical team/staff and remote care management team to support discharge planning, care transitions and ongoing care coordination interventions. -Must be highly motivated, result-oriented with strong skills in presenting, communicating, multi-tasking and time management -Ability to identify problems and recommend solutions -Ability to work independently with minimal supervision -Commitment to improving health equity and supporting vulnerable populations Training and Work Schedules: Your new hire training will take place 8:00am-5:00pm CST, mandatory attendance is required. This position is full-time (40 hours/week). Employees are required to have flexibility to work any of our shift schedules during our normal business hours of Monday-Friday, 7:30am- 4:00pm CST. Remote Details: All U.S. residents are eligible to apply to this position. You will work remotely, full-time. It will require a dedicated, quiet, private, distraction free environment with access to high-speed internet. We will provide you with the computer, technology and equipment needed to successfully perform your job. You will be responsible for providing high-speed internet. Internet requirements include the following: Maintain a secure, high-speed, broadband internet connection (DSL, Cable, or Fiber) at the remote location. Dial-up, satellite, WIFI, Cellular connections are NOT acceptable. · Download speed of 15Mbps (megabyte per second) · Upload speed of 5Mbps (megabyte per second) · Ping Rate Maximum of 30ms (milliseconds) · Hardwired to the router · Surge protector with Network Line Protection for CAH issued equipment Anticipated salary range: $68,600 - $97,800 Bonus eligible: No Benefits: Cardinal Health offers a wide variety of benefits and programs to support health and well-being. - Medical, dental and vision coverage - Paid time off plan - Health savings account (HSA) - 401k savings plan - Access to wages before pay day with myFlexPay - Flexible spending accounts (FSAs) - Short- and long-term disability coverage - Work-Life resources - Paid parental leave - Healthy lifestyle programs Application window anticipated to close: 5/25/2026* if interested in opportunity, please submit application as soon as possible. The salary range listed is an estimate. Pay at Cardinal Health is determined by multiple factors including, but not limited to, a candidate’s geographical location, relevant education, experience and skills and an evaluation of internal pay equity. Candidates who are back-to-work, people with disabilities, without a college degree, and Veterans are encouraged to apply. Cardinal Health supports an inclusive workplace that values diversity of thought, experience and background. We celebrate the power of our differences to create better solutions for our customers by ensuring employees can be their authentic selves each day. Cardinal Health is an Equal Opportunity/Affirmative Action employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, ancestry, age, physical or mental disability, sex, sexual orientation, gender identity/expression, pregnancy, veteran status, marital status, creed, status with regard to public assistance, genetic status or any other status protected by federal, state or local law. To read and review this privacy notice click here