Member Services Processing Specialist

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Member Services Processing Specialist based in the United States. This is a fully remote, full-time opportunity supporting a federally administered healthcare program with a meaningful mission. The role focuses on reviewing and processing member applications, certifications, transfers, appeals, and supporting documentation. You’ll play an important role in ensuring members receive accurate, timely, and compliant service throughout their program experience. The position combines careful documentation review and data processing with direct communication with members, providers, and internal teams. You’ll work within established procedures while contributing to quality assurance, cross-training, and continuous process improvements. Success requires strong attention to detail, service orientation, adaptability, and the ability to manage competing priorities. This is an excellent opportunity for an organized professional seeking to build experience in healthcare operations and mission-driven service delivery. Member application processing: Process enrollment applications, certifications, transfers, appeals, designated representative appointments, updates, and other service requests in accordance with program policies, standard operating procedures, and federal requirements. Documentation review: Examine member-submitted documentation for completeness, accuracy, eligibility, and compliance, determining whether materials satisfy applicable program requirements. Data entry and case management: Enter and update information accurately within member services systems, digital mail center tools, entry portals, and intelligent document processing platforms, ensuring documentation is properly routed and processed on time. Case documentation: Maintain accurate case notes, records, and supporting documentation to facilitate program reviews, compliance requirements, and audit readiness. Member and stakeholder support: Communicate professionally with members, healthcare providers, and internal stakeholders regarding documentation requirements, missing information, processing status, and other service-related questions. Escalation management: Identify complex or ambiguous cases and escalate them appropriately to the Member Services Processing Supervisor for guidance and resolution. Privacy and compliance: Protect sensitive information by adhering to HIPAA requirements, privacy policies, and procedures governing personally identifiable and protected health information. Quality assurance: Identify processing errors, recurring trends, and opportunities for improvement, sharing observations and recommendations with leadership. Cross-training: Participate in training and process updates to provide effective support across enrollment, record maintenance, appeals routing, member correspondence, and related workflows. Continuous improvement: Contribute ideas and feedback regarding workflow challenges, system issues, process inefficiencies, and potential operational enhancements. Requirements Education: High school diploma or equivalent required. Experience: 1–3 years of experience in processing, administrative support, data entry, customer service, healthcare operations, or a related operational environment. Documentation skills: Strong attention to detail and demonstrated ability to review and analyze documentation against established requirements. Communication: Strong written and verbal communication skills, with the ability to interact professionally with members, providers, colleagues, and other stakeholders. Process discipline: Ability to follow detailed procedures accurately, maintain consistent documentation, meet deadlines, and operate within established compliance requirements. Problem-solving: Strong customer problem-solving skills and sound judgment when identifying discrepancies, missing information, or cases requ