Member Services Processing Specialist

Before you apply

Job source

Himalayas

Applying on

himalayas.app

Workplace

Fully remote

US state

Nationwide remote

Category

Customer Service

Link last checked

Not checked yet

Posted

2 weeks ago

Closes

10/29/2026

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About the role

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: Contact Center Job Qualifications: Skills: Collaboration, Customer Problem Solving, Customer Service, Microsoft Applications, Multitasks Well (Inactive) Certifications: None Experience: 1 + years of related experience US Citizenship Required: No Job Description: The World Trade Center Health Program is a limited federal health program administered by the National Institute for Occupational Safety and Health (NIOSH), part of the Centers for Disease Control and Prevention (CDC) in the U.S. Department of Health and Human Services (HHS). The Program provides no-cost medical monitoring and treatment for certified WTC-related health conditions to those directly affected by the 9/11 attacks in New York, the Pentagon, and in Shanksville, Pennsylvania. Summary: 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. This role plays a critical part in ensuring members experience a smooth and efficient program experience, maintaining accuracy, compliance, and service quality across all processing activities. The specialist works closely with supervisors and cross‑functional teams, utilizing member services systems and tools to support timely and compliant workflow execution. Responsibilities: Process enrollment applications, documentation, certifications, transfers, appeals, and designated representative appointments and updates in accordance with program policies, SOPs, and federal requirements. Review member-submitted materials for completeness, accuracy, and eligibility, ensuring all required data is properly captured and validated. Analyze documentation submitted with the application and assess if the submission meets the requirements of program enrollment. Perform data entry and record updates within member services tools—including digital mail center systems, entry portal, and intelligent document processing platforms—ensuring timely routing and processing of member documentation. Maintain accurate and high-quality case notes, documentation, and processing records for program review, compliance, and audit readiness. Communicate professionally with members, providers, and internal stakeholders regarding documentation requirements, missing information, or status updates. Escalate complex or ambiguous cases to the Member Services Processing Supervisor for review and guidance. Adhere to HIPAA and program privacy requirements when handling PII/PHI. Support quality assurance activities by identifying errors, trends, or potential improvements and providing feedback to leadership. Participate in cross‑training and process updates to ensure efficient support across multiple workflows, including enrollment, record updates, appeals routing, and member correspondence. Contribute to continuous improvement efforts by providing insight into workflow challenges, system issues, or enhancement opportunities. Core Competencies Accuracy and Quality Service Orientation Problem Solving Accountability Process Discipline Adaptability and Learning Agility Team Collaboration Required Qualifications High School Diploma or equivalent. 1–3 years of experience in processing, administrative support, data entry, customer service, or a related operational role. Strong written and verbal communication skills. Ability to follow detailed procedures, meet deadlines, and adapt to changing priorities. Strong attention to detail with the ability to analyze documentation to determine if it meets program requirements. Location: Remote Clearance: Must be able to obtain and maintain a Public Trust Travel: 0-10% Preferred Qualifications Background supporting fede

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