Member Services Processing Specialist

🔥 13 hours ago

🇺🇸 United States – Remote

💵 $72.9k - $98.6k / year

⏰ Full Time

🟢 Junior

🚫👨‍🎓 No degree required

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

👻 Ghost score 0%

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General Dynamics Information Technology

WebsiteLinkedInAll Job Openings

10,000+ employees

Founded 1954

💼 Consulting

🏥 Healthcare

📦 Logistics

Consulting • Healthcare • Logistics

General Dynamics Information Technology is a company at the forefront of technological innovation, offering a wide range of services including consulting, digital modernization, and application services. The company is heavily involved in implementing solutions related to artificial intelligence, cloud computing, cybersecurity, high-performance computing, and quantum technologies. GDIT is committed to supporting government and defense sectors, providing mission-critical services such as logistics and supply chain management, intelligence, and homeland security. The company also focuses on diverse and inclusive hiring practices and actively promotes employee well-being. Through its digital accelerator solutions and pioneering use of emerging technologies, GDIT aims to propel agencies' missions forward and address complex technological challenges.

📋 Description

• Review, validate, and process member applications, certifications, transfers, appeals, designated representative appointments, documentation, and service requests • Own end-to-end processing of enrollment applications, certifications, transfers, appeals, designated representative appointments, and member record updates • Review member-submitted materials for completeness, accuracy, and eligibility • Determine follow-up actions and coordinate with members, providers, and internal stakeholders • Evaluate documentation against program enrollment and certification criteria • Identify edge cases and recommend resolution paths • Use digital mail center systems, intake/entry portals, and intelligent document processing platforms to triage, route, and process documentation • Maintain case notes and processing records for audits, compliance reviews, and operational analytics • Partner with supervisors and cross-functional teams to resolve complex scenarios and improve workflow efficiency • Monitor backlog, turnaround time, accuracy rate, and other operational metrics • Contribute to corrective actions and continuous improvement initiatives • Escalate ambiguous or high-risk cases with clear documentation and decision rationale • Support quality assurance by identifying trends and error drivers • Participate in cross-training for enrollment, record updates, appeals routing, designated representative processing, and member correspondence • Apply policies and SOPs with discretion, identify exceptions, and propose resolution options • Prioritize work using risk-based criteria and service levels • Recommend process improvements and contribute to SOP updates • Participate in validation and testing when new procedures or tools are introduced

🎯 Requirements

• High School Diploma or equivalent • 1–3 years of experience in processing, administrative support, data entry, customer service, or related operations • Strong written and verbal communication skills • Ability to follow detailed procedures, meet deadlines, and adapt to changing priorities • Demonstrated analytical skills with close attention to detail • Ability to evaluate documentation against defined program requirements • Background supporting federal health programs or healthcare operations preferred • Experience with intelligent document processing tools, member service portals, or customer support platforms preferred • Exposure to HIPAA-regulated environments and familiarity with handling PII/PHI preferred • No US citizenship required • Must handle PII/PHI in accordance with HIPAA and program privacy requirements • Must follow security and access controls

🏖️ Benefits

• Full-flex work week to own your priorities at work and at home • 401K with company match • Comprehensive health and wellness packages • Internal mobility team dedicated to helping you own your career • Professional growth opportunities including paid education and certifications • Cutting-edge technology you can learn from • Paid vacation and holidays • Medical plan options, including plans with Health Savings Accounts • Dental plan options • Vision plan options • Paid time off including vacation, sick, personal time, holidays, parental, military, bereavement, and jury duty leave • Typically 15 days of paid leave per calendar year • 10 paid holidays per year • 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 • Identity verification process using advanced biometrics and artificial intelligence