Member Services Processing Specialist

General Dynamics Information Technology, Inc.; New York, Shanksville (NY, PA); Hybride; USD 42 000 - 65 000; Plein temps

Avantages offerts par ce poste

401K with company match

Comprehensive health coverage

Paid time off

Résumé du poste

General Dynamics Information Technology, Inc. is seeking a Member Services Processing Specialist to support day‑to‑day operations within a federal health program.

You will review, validate, and process member applications, certifications, transfers, and appeals, ensuring accuracy and compliance across processing activities. You will collaborate with supervisors and cross‑functional teams, using member services systems to route and complete work efficiently while maintaining data integrity and

Qualifications

• Minimum high school diploma or equivalent.
• 1–3 years of processing, administrative support, data entry, or related roles.
• Strong written and verbal communication skills.
• Ability to follow detailed procedures and meet deadlines.
• Attention to detail to ensure program requirements are met.

Responsabilités

• Process enrollment applications, documentation, certifications, transfers, appeals, and designated representative appointments per policies and federal requirements.
• Review materials for completeness, accuracy, and eligibility.
• Analyze documentation to determine enrollment readiness.
• Enter data and update records in member services tools with timely processing.
• Maintain accurate case notes and processing records for audit readiness.
• Communicate with members, providers, and internal stakeholders about requirements and status.
• Escalate complex cases to supervision as needed.
• Adhere to HIPAA and privacy requirements for PII/PHI.
• Support quality assurance by identifying errors and improvement opportunities.
• Participate in cross-training and process updates across workflows.

Connaissances

Accuracy and Quality

Service Orientation

Problem Solving

Accountability

Process Discipline

Adaptability and Learning Agility

Team Collaboration

Formation

High School Diploma or equivalent

Outils

ServiceNow

CXone

Intelligent Document Processing

Description du poste

Job Description

The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania.

Summary:
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. This role plays a critical part in ensuring members experience a smooth and efficient program experience, maintaining accuracy, compliance, and service quality across all processing activities. The specialist works 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—including digital mail center systems, entry portal, and intelligent document processing platforms—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, including enrollment, record updates, appeals routing, and member correspondence.

• Contribute to continuous improvement efforts by providing insight into workflow challenges, system issues, or enhancement opportunities.

Core Competencies

• Accuracy and Quality

• Service Orientation

• Problem Solving

• Accountability

• Process Discipline

• Adaptability and Learning Agility

• Team Collaboration

Required 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.

• 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.

GDIT IS YOUR PLACE:

• 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 certificates.

• Cutting-edge technology you can learn from.

• Rest and recharge with paid vacation and holidays.

#GDITFedHealthJobs

#GDITWTCJobs