Healthcare TPA Member Services Processing Analyst

Member Services Process Analyst Summary: The Member Services Process Analyst 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 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. High School Diploma or equivalent. 1–3 years of experience in processing, administrative support, data entry, customer service, or a related operational role. Preferred Qualifications Background supporting federal health programs or healthcare operations. Experience working with intelligent document processing tools, member service portals, or customer support platforms such as ServiceNow or CXone. EEO Statement Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans #J-18808-Ljbffr General Dynamics Information Technology