Member Services Processing Specialist
About The Position
The Member Services Processing Specialist supports day-to-day operations in a Third-Party Administrator healthcare environment for the World Trade Center Health Program, a limited federal health program administered by NIOSH within the CDC and HHS. The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to people directly affected by the September 11 attacks in New York, at the Pentagon, and in Shanksville, Pennsylvania. The specialist reviews, validates, and processes member applications, certifications, transfers, appeals, designated representative appointments, documentation, and service requests. The role supports an efficient member experience while maintaining accuracy, compliance, and service quality. It works with supervisors and cross-functional teams and uses member services systems and tools to execute workflows in a timely and compliant manner. This position is remote, with a scheduled 40-hour workweek and 0–10% travel.
Requirements
- High school diploma or equivalent.
- 1–3 years of experience in processing, administrative support, data entry, customer service, or a related operational role.
- Strong written and verbal communication skills.
- Ability to follow detailed procedures, meet deadlines, and adapt to changing priorities.
- Strong attention to detail and ability to analyze documentation against program requirements.
- Skills in collaboration, customer problem solving, customer service, Microsoft applications, and multitasking.
- Must be able to obtain and maintain a Public Trust clearance.
Nice To Haves
- Background supporting federal health programs or healthcare operations.
- Experience with intelligent document processing tools, member service portals, or customer support platforms such as ServiceNow or CXone.
Responsibilities
- Process enrollment applications, documentation, certifications, transfers, appeals, and designated representative appointments and updates according to program policies, standard operating procedures, and federal requirements.
- Review member-submitted materials for completeness, accuracy, and eligibility, ensuring required data is captured and validated.
- Analyze application documentation to assess whether submissions meet program enrollment requirements.
- Enter data and update records in member services tools, including digital mail center systems, an entry portal, and intelligent document processing platforms; route and process member documentation promptly.
- Maintain accurate, high-quality case notes, documentation, and processing records for program review, compliance, and audit readiness.
- Communicate professionally with members, providers, and internal stakeholders about documentation requirements, missing information, and status updates.
- Escalate complex or ambiguous cases to the Member Services Processing Supervisor for review and guidance.
- Follow HIPAA and program privacy requirements when handling personally identifiable and protected health information.
- Support quality assurance by identifying errors, trends, and potential improvements and providing feedback to leadership.
- Participate in cross-training and process updates to support workflows such as enrollment, record updates, appeals routing, and member correspondence.
- Contribute insights about workflow challenges, system issues, and opportunities for improvement.
Benefits
- 401(k) with company match.
- Medical plan options, including some with Health Savings Accounts.
- Dental plan options.
- Vision plan.
- Paid education and certifications.
- Paid vacation, sick and personal time, and holidays.
- Paid parental leave, including up to 160 hours through the GDIT Paid Family Leave program for eligible employees.
- Disability benefits, including short- and long-term disability.
- Life insurance and other insurance offerings, including accidental death and dismemberment, personal accident, critical illness, and business travel and accident insurance.
- Full-flex work weeks where possible.
- Internal mobility and professional growth opportunities.
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
