Senior Benefits Processing & Compliance Specialist

Businessolver; Indiana (PA); On-site; USD 22,000 - 29,000; Full time

Job summary

Businessolver in Pennsylvania is seeking a Special Processing Specialist II to deliver advanced HR support with a focus on benefit processing, compliance, and member services. You will handle complex cases, ensure HIPAA/IRS/CMS compliance, and mentor junior staff while supporting efficient workflows.

The role involves reviewing appeals, verifying eligibility, processing life and disability claims, and maintaining secure, accurate records.

Qualifications

• Bachelor’s degree preferred in HR, 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.

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.

Skills

Communication skills

Attention to detail

Confidential information handling

Team collaboration

Critical thinking

Education

Bachelor’s degree preferred in HR or related field

Tools

HRIS

Microsoft Office

Job description

Businessolver in Pennsylvania is seeking a Special Processing Specialist II to deliver advanced HR support with a focus on benefit processing, compliance, and member services. You will handle complex cases, ensure HIPAA/IRS/CMS compliance, and mentor junior staff while supporting efficient workflows.

The role involves reviewing appeals, verifying eligibility, processing life and disability claims, and maintaining secure, accurate records.