Processing Specialist I - Special Processing (Remote)

Businessolver

9h•Remote

About The Position

The Processing Specialist I - Special Processing provides advanced HR support focusing on benefit processing, compliance, and member services. Responsible for managing complex cases including condolence management, QMCSO compliance, benefit appeals, POA documentation, and Medicare L564 requests. Ensures accuracy, compliance with HIPAA, IRS, and CMS regulations, and maintains workflow continuity. Supports process improvements and mentors junior staff. Requires professional communication with members, teams, and partners, handling escalations and reporting activities.

Requirements

Bachelor’s degree preferred in Human Resources, Business Administration, or related field.
2–3 years experience in HR operations or employee support.
Strong knowledge of benefits processing and compliance requirements.
Proficiency with HRIS and Microsoft Office.
Excellent attention to detail and ability to manage confidential information.
Strong communication skills and ability to work collaboratively while adhering to HIPAA, IRS, and CMS regulations.

Responsibilities

Review and process appeals, condolences, QMCSO orders, Medicare L-564 forms, and POA requests accurately.
Verify eligibility and manage elections, record updates, and coverage activation per SOPs.
Submit life and disability claims timely with complete and correct information.
Apply client-specific requirements across multiple workstreams.
Provide proactive, accurate, and empathetic support to enhance member experience.
Communicate professionally with members, internal teams, and external partners.
Maintain compliance with HIPAA, IRS, CMS regulations and manage mandated notices and documentation.
Identify and resolve documentation or process issues using critical thinking and compliance standards.
Protect sensitive data and maintain transaction integrity.
Meet attendance and performance goals; take ownership through task resolution.
Handle escalations, assist during client calls, and prepare activity and performance reports.
Participate in daily stand-ups and foster team collaboration.