Member Services Processing Specialist

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

None

Job Family:

Process and Operational Efficiency

Job Qualifications:

Skills:

Collaboration, Customer Problem Solving, Customer Service, Microsoft Applications, Multitasking

Certifications:

None

Experience:

1 + years of related experience

US Citizenship Required:

No

Job 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. The specialist ensures an efficient and positive program experience for members while maintaining accuracy, compliance, and service quality across all processing activities.

Key Responsibilities

• Own end‑to‑end processing of enrollment applications, certifications, transfers, appeals, designated representative appointments, and member record updates in accordance with program policies, SOPs, and applicable federal requirements.
• Perform detailed reviews of member‑submitted materials to validate completeness, accuracy, and eligibility; determine required follow‑up actions and coordinate with members, providers, and internal stakeholders.
• Exercise independent judgment to evaluate documentation against program enrollment and certification criteria; identify edge cases and recommend resolution paths.
• Use member services tools (digital mail center systems, intake/entry portals, intelligent document processing platforms) to triage, route, and process documentation, ensuring service‑level adherence.
• Maintain high‑quality case notes and processing records to support program audits, compliance reviews, and operational analytics.
• Partner with supervisors and cross‑functional teams (member services, clinical policy, provider services, call center, data/reporting) to resolve complex scenarios and improve workflow efficiency.
• Monitor operational metrics (e.g., backlog, turnaround time, accuracy rate) and contribute to corrective actions and continuous improvement initiatives.
• Handle PII/PHI in accordance with HIPAA and program privacy requirements; follow security and access controls.
• Escalate ambiguous or high‑risk cases with clear documentation and decision rationale; support quality assurance by identifying trends and error drivers.
• Participate in cross‑training to provide surge coverage across enrollment, record updates, appeals routing, designated representative processing, and member correspondence.

Decision Rights and Scope

• Applies established policies and SOPs with discretion; identifies exceptions and proposes resolution options to leadership.
• Prioritizes work using risk‑based criteria and service levels; determines appropriate sequencing and follow‑up actions.
• Recommends process improvements and contributes to SOP updates; participates in validation/testing when new procedures or tools are introduced.

Required Qualifications

• High School Diploma or equivalent.
• 1–3 years of experience in processing, administrative support, data entry, customer service, or related operations.
• Strong written and verbal communication skills.
• Ability to follow detailed procedures, meet deadlines, and adapt to changing priorities.
• Demonstrated analytical skills with close attention to detail; capable of evaluating documentation against defined program requirements.

Preferred Qualifications

• Background supporting federal health programs or healthcare operations.
• Experience with intelligent document processing tools, member service portals, or customer support platforms (e.g., ServiceNow, CXone).
• Exposure to HIPAA‑regulated environments and familiarity with handling PII/PHI.

Core Competencies

• Accuracy and Quality
• Service Orientation
• Problem Solving
• Accountability
• Process Discipline
• Adaptability and Learning Agility
• Team Collaboration

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 certifications.

• Cutting-edge technology you can learn from.

• Rest and recharge with paid vacation and holidays.

#GDITFedHealthJobs

#GDITWTCJobs

The likely salary range for this position is $72,877 - $98,599. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

Our Identity Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

About Our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.Join our Talent Community to stay up to date on our career opportunities and events at

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans