Member Services Processing Specialist

This is a fully remote position, open to applicants in United States.

📋 Description

• Manage enrollment applications, including documentation, certifications, transfers, appeals, and updates for designated representatives.

• Assess member-submitted documents for thoroughness, precision, and eligibility.

• Evaluate application materials against the criteria for program enrollment.

• Conduct data entry and maintain records within digital mail center systems, entry portals, and intelligent document processing platforms.

• Ensure accurate case notes, documentation, and processing records to comply with audit readiness requirements.

• Liaise with members, providers, and internal teams regarding documentation needs, missing information, and updates on status.

• Refer complex or unclear cases to the Member Services Processing Supervisor.

• Comply with HIPAA and program privacy standards when handling PII/PHI.

• Assist in quality assurance by identifying mistakes, trends, and areas for potential improvement.

• Engage in cross-training and updates related to enrollment, record updates, appeals routing, and member communications.

• Contribute to ongoing enhancements by pinpointing workflow challenges, system problems, and opportunities for improvement.

⛳️ Requirements

• High School Diploma or equivalent.

• 1–3 years of experience in processing, administrative support, data entry, customer service, or a similar operational role.

• Excellent written and verbal communication abilities.

• Capability to adhere to detailed procedures, meet deadlines, and adjust to shifting priorities.

• Strong attention to detail, with the ability to analyze documents to confirm they fulfill program standards.

• Proficient in collaboration, problem-solving for customers, customer service, Microsoft Applications, and multitasking.

• Must be capable of obtaining and maintaining a Public Trust.

• Experience supporting federal health programs or healthcare operations is preferred.

• Familiarity with intelligent document processing tools, member service portals, or customer support platforms such as ServiceNow or CXone is preferred.

• No US citizenship required.

🏝️ Benefits

• Full-flex work week.

• 401(k) with company match.

• Comprehensive health and wellness packages.

• Internal mobility team.

• Professional growth opportunities, including paid education and certifications.

• Cutting-edge technology to learn from.

• Paid vacation and holidays.

• Medical plan options, including some with Health Savings Accounts.

• Dental plan options.

• Vision plan.

• Paid time off, including vacation, sick, personal, parental, military, bereavement, and jury duty leave.

• Up to 160 hours of paid family leave in a rolling 12-month period for eligible employees.

• Short- and long-term disability benefits.

• Life insurance.

• Accidental death and dismemberment insurance.

• Personal accident insurance.

• Critical illness insurance.

• Business travel and accident insurance.