Member Services Senior Processor

Accountabilities

• • Complex case processing: Process high-complexity applications, certifications, transfers, appeals, and supporting documentation, applying program requirements and detailed analysis to ensure accurate outcomes.
  • Escalation support: Serve as a lead processor and primary escalation point for complex cases that can be resolved without supervisor intervention, providing guidance to junior processing staff.
  • Workflow coordination: Assist supervisors with workflow oversight, case assignments, workload coordination, and quality monitoring to support efficient operations.
  • Quality assurance: Review completed work from less-experienced processors for accuracy, completeness, compliance, and adherence to established procedures, providing constructive feedback where needed.
  • Training and mentoring: Train and support team members on program policies, procedures, systems, and applicable regulatory requirements while helping strengthen overall team capabilities.
  • Reporting and analysis: Identify processing trends, document operational issues, and contribute to performance reporting and data collection used to improve service delivery.
  • Stakeholder communication: Communicate professionally with internal and external stakeholders regarding sensitive, complex, or escalated processing matters.
  • Process improvement: Contribute to workflow optimization, system enhancements, process development, and operational improvements that increase quality and efficiency.
  • Compliance and audit readiness: Help maintain accurate documentation and support preparation for audits, compliance reviews, and other program oversight activities.

  Requirements

  • Education: High school diploma or equivalent required.
  • Experience: 3–5 years of experience in processing, administrative support, operations, customer service, or another high-volume service environment.
  • Processing expertise: Strong understanding of documentation review, eligibility requirements, member processing workflows, and regulatory considerations.
  • Communication: Excellent written and verbal communication skills, with the ability to handle sensitive or complex matters professionally.
  • Problem-solving: Strong analytical and problem-solving abilities, with sound judgment when reviewing documentation and resolving escalated cases.
  • Leadership: Ability to provide guidance and mentoring to colleagues and take on limited workflow oversight responsibilities while supporting supervisors.
  • Organization: Strong attention to detail and the ability to manage multiple cases, priorities, and deadlines in a high-volume operational environment.
  • Technology: Comfortable working with Microsoft applications and operational systems used for member service, documentation, and case processing.
  • Preferred experience: Background supporting federal healthcare programs, healthcare operations, member service portals, or customer support platforms such as ServiceNow or CXone.
  • Additional considerations: Familiarity with intelligent document processing tools is a plus. No security clearance or U.S. citizenship is required.

  Benefits

  • Compensation: Expected hourly rate of $20.40–$27.60, with actual compensation determined based on experience, geographic location, and applicable contractual requirements.
  • Remote work: Fully remote position with a full-flex work week designed to support work-life balance.
  • Retirement: 401(k) plan with company matching, with pre-tax and post-tax contribution options.
  • Healthcare: Comprehensive medical plan options, including options with Health Savings Accounts, plus dental and vision coverage.
  • Paid time off: Vacation, sick, personal, and holiday leave, with new employees typically receiving 15 days of paid leave per calendar year plus 10 paid holidays, subject to eligibility and prorating.
  • Family leave: Paid parental and family leave, including up to 160 hours through the paid family leave program for eligible employees.
  • Insurance protection: Short- and long-term disability, life insurance, accidental death and dismemberment, personal accident, critical illness, and business travel and accident coverage.
  • Professional development: Paid education and certification opportunities, along with ongoing professional growth programs.
  • Career mobility: Access to an internal mobility team dedicated to helping employees develop and advance their careers.
  • Technology exposure: Opportunities to work with modern technologies and develop skills in areas including AI, cloud, cybersecurity, and software solutions.