[Hiring] Member Services Processing Specialist @General Dynamics Information Technology

Role Description

The Member Services Processing Specialist supports day‑to‑day operations within a Third‑Party Administrator (TPA) healthcare environment by:

• Reviewing, validating, and processing member applications, certifications, transfers, appeals, designated representative appointments, documentation, and service requests.
• Ensuring members experience a smooth and efficient program experience, maintaining accuracy, compliance, and service quality across all processing activities.
• Working closely with supervisors and cross‑functional teams, utilizing member services systems and tools to support timely and compliant workflow execution.

Responsibilities

• Process enrollment applications, documentation, certifications, transfers, appeals, and designated representative appointments and updates in accordance with program policies, SOPs, and federal requirements.
• Review member-submitted materials for completeness, accuracy, and eligibility, ensuring all required data is properly captured and validated.
• Analyze documentation submitted with the application and assess if the submission meets the requirements of program enrollment.
• Perform data entry and record updates within member services tools, ensuring timely routing and processing of member documentation.
• Maintain accurate and high-quality case notes, documentation, and processing records for program review, compliance, and audit readiness.
• Communicate professionally with members, providers, and internal stakeholders regarding documentation requirements, missing information, or status updates.
• Escalate complex or ambiguous cases to the Member Services Processing Supervisor for review and guidance.
• Adhere to HIPAA and program privacy requirements when handling PII/PHI.
• Support quality assurance activities by identifying errors, trends, or potential improvements and providing feedback to leadership.
• Participate in cross‑training and process updates to ensure efficient support across multiple workflows.
• Contribute to continuous improvement efforts by providing insight into workflow challenges, system issues, or enhancement opportunities.

Qualifications

• 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 with the ability to analyze documentation to determine if it meets program requirements.

Requirements

• Location: Remote
• Clearance: Must be able to obtain and maintain a Public Trust
• Travel: 0-10%

Preferred Qualifications

• Background supporting federal health programs or healthcare operations.
• Experience working with intelligent document processing tools, member service portals, or customer support platforms such as ServiceNow or CXone.

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.
• Rest and recharge with paid vacation and holidays.

Compensation

The likely hourly rate for this position is between $22.97 - $31.07. Salary will be set based on experience, geographic location, and possibly contractual requirements.

Scheduled Weekly Hours

40

Travel Required

Less than 10%

Telecommuting Options

Remote