Member Services Senior Processor

Accountabilities Complex case processing: Process high-complexity applications, certifications, transfers, appeals, and supporting documentation, applying program requirements and detailed analysis to ensure accurate outcomes.

Escalation support: Serve as a lead processor and primary escalation point for complex cases that can be resolved without supervisor intervention, providing guidance to junior processing staff.

Workflow coordination: Assist supervisors with workflow oversight, case assignments, workload coordination, and quality monitoring to support efficient operations.

Quality assurance: Review completed work from less-experienced processors for accuracy, completeness, compliance, and adherence to established procedures, providing constructive feedback where needed.

Training and mentoring: Train and support team members on program policies, procedures, systems, and applicable regulatory requirements while helping strengthen overall team capabilities.

Reporting and analysis: Identify processing trends, document operational issues, and contribute to performance reporting and data collection used to improve service delivery.

Stakeholder communication: Communicate professionally with internal and external stakeholders regarding sensitive, complex, or escalated processing matters.

Process improvement: Contribute to workflow optimization, system enhancements, process development, and operational improvements that increase quality and efficiency.

Compliance and audit readiness: Help maintain accurate documentation and support preparation for audits, compliance reviews, and other program oversight activities.

Requirements

Education: High school diploma or equivalent required.

Experience: 3–5 years of experience in processing, administrative support, operations, customer service, or another high-volume service environment.

Processing expertise: Strong understanding of documentation review, eligibility requirements, member processing workflows, and regulatory considerations.

Communication: Excellent written and verbal communication skills, with the ability to handle sensitive or complex matters professionally.

Problem-solving: Strong analytical and problem-solving abilities, with sound judgment when reviewing documentation and resolving escalated cases.

Leadership: Ability to provide guidance and mentoring to colleagues and take on limited workflow oversight responsibilities while supporting supervisors.

Organization: Strong attention to detail and the ability to manage multiple cases, priorities, and deadlines in a high-volume operational environment.

Technology: Comfortable working with Microsoft applications and operational systems used for member service, documentation, and case processing.

Preferred experience: Background supporting federal healthcare programs, healthcare operations, member service portals, or customer support platforms such as ServiceNow or CXone.

Additional considerations: Familiarity with intelligent document processing tools is a plus. No security clearance or U.S. citizenship is required.

Benefits

Compensation: Expected hourly rate of $20.40–$27.60 , with actual compensation determined based on experience, geographic location, and applicable contractual requirements.

Remote work: Fully remote position with a full-flex work week designed to support work-life balance.

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

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

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

Family leave: Paid parental and family leave, including up to 160 hours through the paid family leave program 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, along with ongoing professional growth programs.

Career mobility: Access to an internal mobility team dedicated to helping employees develop and advance their careers.

Technology exposure: Opportunities to work with modern technologies and develop skills in areas including AI, cloud, cybersecurity, and software solutions.

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? 

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