Member Services Processing Specialist

General Dynamics
United States
Workplace: RemoteFull timeUSD 72,877 - 98,599 annuallyFunction: Solutions Engineering & Sales EngineeringExperience: 1-3 yearsEducation: high_schoolSkills: ["Collaboration","Customer problem solving","Customer service","Accuracy","Service orientation","Problem solving","Accountability","Process discipline","Adaptability","Learning agility"]

Support day-to-day operations in a TPA healthcare environment by processing and validating member applications, certifications, transfers, appeals, and record updates. Review member-submitted documentation for completeness, accuracy, and eligibility, using member services tools to triage and route cases while meeting service levels. Maintain high-quality case notes for audits and analytics, handle PII/PHI in line with HIPAA requirements, and escalate high-risk issues with clear rationale.

Loading

Loading job details...

Preparing the role view and application actions.

FursaFursa
General Dynamics
General Dynamics
1 day ago

Member Services Processing Specialist

✓ Verified Job

Canonical indexed version, validated from employer's careers page.

Source: Company careers pageValidated by: Fursa AI
Last checked: 5 hours agoStatus: Live

Job Summary

Support day-to-day operations in a TPA healthcare environment by processing and validating member applications, certifications, transfers, appeals, and record updates. Review member-submitted documentation for completeness, accuracy, and eligibility, using member services tools to triage and route cases while meeting service levels. Maintain high-quality case notes for audits and analytics, handle PII/PHI in line with HIPAA requirements, and escalate high-risk issues with clear rationale.
Location: United States
Workplace: Remote
Employment Type: Full time
Job Function: Solutions Engineering & Sales Engineering
Seniority: Entry level

Key Responsibilities

  • •Own end-to-end processing of enrollment applications, certifications, transfers, appeals, designated representative appointments, and member record updates in line with program policies and SOPs.
  • •Review member-submitted materials to validate completeness, accuracy, and eligibility, and coordinate follow-up actions with members, providers, and internal stakeholders.
  • •Evaluate documentation against program enrollment/certification criteria, identify edge cases, and recommend resolution paths.
  • •Use member services tools to triage, route, and process documentation while ensuring service-level adherence and maintaining accurate records.
  • •Handle PII/PHI in accordance with HIPAA and privacy requirements; escalate ambiguous or high-risk cases with clear documentation and rationale.
Travel: Low travel

Pay and Benefits

Salary: USD 72,877 - 98,599 annually
Perks:401kHealth InsuranceDentalVisionRemote WorkPaid LeaveParental LeaveLearning Budget

Key Requirements

  • •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.
  • •Analytical skills with close attention to detail to evaluate documentation against defined program requirements.
Experience:1-3 yearsHealthcareTPA healthcareFederal health programs
Education:High School
Skills:CollaborationCustomer problem solvingCustomer serviceAccuracyService orientationProblem solvingAccountabilityProcess disciplineAdaptabilityLearning agility
Tech Stack:Microsoft ApplicationsServiceNowCXone

Company Brief

General Dynamics
Provides IT, systems engineering, cybersecurity, cloud, and mission support services to U.S. federal civilian and defense agencies, delivering large-scale technology solutions and managed services for national security and government operations.
Industry: Defense Technology
Company Size: Enterprise (1,001+ employees)
Growth: Established Company
Headquarters: Tysons / Fairfax, United States
WebsiteLinkedIn