Member Services Processing Specialist

Accountabilities Member application processing: Process enrollment applications, certifications, transfers, appeals, designated representative appointments, updates, and other service requests in accordance with program policies, standard operating procedures, and federal requirements.

Documentation review: Examine member-submitted documentation for completeness, accuracy, eligibility, and compliance, determining whether materials satisfy applicable program requirements.

Data entry and case management: Enter and update information accurately within member services systems, digital mail center tools, entry portals, and intelligent document processing platforms, ensuring documentation is properly routed and processed on time.

Case documentation: Maintain accurate case notes, records, and supporting documentation to facilitate program reviews, compliance requirements, and audit readiness.

Member and stakeholder support: Communicate professionally with members, healthcare providers, and internal stakeholders regarding documentation requirements, missing information, processing status, and other service-related questions.

Escalation management: Identify complex or ambiguous cases and escalate them appropriately to the Member Services Processing Supervisor for guidance and resolution.

Privacy and compliance: Protect sensitive information by adhering to HIPAA requirements, privacy policies, and procedures governing personally identifiable and protected health information.

Quality assurance: Identify processing errors, recurring trends, and opportunities for improvement, sharing observations and recommendations with leadership.

Cross-training: Participate in training and process updates to provide effective support across enrollment, record maintenance, appeals routing, member correspondence, and related workflows.

Continuous improvement: Contribute ideas and feedback regarding workflow challenges, system issues, process inefficiencies, and potential operational enhancements.

Requirements

Education: High school diploma or equivalent required.

Experience: 1–3 years of experience in processing, administrative support, data entry, customer service, healthcare operations, or a related operational environment.

Documentation skills: Strong attention to detail and demonstrated ability to review and analyze documentation against established requirements.

Communication: Strong written and verbal communication skills, with the ability to interact professionally with members, providers, colleagues, and other stakeholders.

Process discipline: Ability to follow detailed procedures accurately, maintain consistent documentation, meet deadlines, and operate within established compliance requirements.

Problem-solving: Strong customer problem-solving skills and sound judgment when identifying discrepancies, missing information, or cases requiring escalation.

Organization: Ability to multitask effectively, manage changing priorities, and maintain accuracy in a high-volume processing environment.

Technology: Comfortable using Microsoft applications and digital systems for documentation, data entry, case processing, and communication.

Adaptability: Demonstrated learning agility and willingness to participate in cross-training and adopt updated processes and technologies.

Preferred experience: Experience supporting federal health programs or healthcare operations is advantageous.

Preferred technology: Familiarity with intelligent document processing tools, member service portals, or platforms such as ServiceNow or CXone is a plus.

Work arrangement: Fully remote, with a standard 40-hour work week and limited travel of less than 10%.

Clearance: The role requires the ability to obtain and maintain a Public Trust designation.

Benefits

Compensation: Expected hourly rate of $19.55–$26.45 , with actual compensation based on experience, geographic location, and applicable contractual requirements.

Remote flexibility: Fully remote work with a full-flex work week designed to support professional and personal priorities.

Healthcare: Multiple medical plan options, including options with Health Savings Accounts, plus dental and vision coverage.

Retirement: 401(k) plan with company matching and pre-tax and post-tax contribution options.

Paid time off: Vacation, sick, personal, and holiday leave. New employees typically receive 15 days of paid leave per calendar year plus 10 paid holidays, subject to eligibility and prorating.

Family leave: Paid parental leave and a paid family leave program providing up to 160 hours during a rolling 12-month period for eligible employees.

Insurance protection: Short- and long-term disability, life insurance, accidental death and dismemberment, personal accident, critical illness, and business travel and accident coverage.

Professional development: Paid education and certification opportunities to support continuous learning and career growth.

Career mobility: Access to internal career mobility resources designed to help employees develop and advance professionally.

Technology exposure: Opportunities to learn and work with modern technologies and tools supporting healthcare and mission-focused operations.

How Jobgether works: We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best!  Why Apply Through Jobgether? 

Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time.

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