Member Services Processing Specialist

Public Trust: None

Requisition Type: Regular

Your Impact

Own your opportunity to be on the frontlines of health innovation. Deliver for America’s health agency missions and enhance lives for hundreds of millions every day.

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 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.

GDIT IS YOUR PLACE:

• Full-flex work week to own your priorities at work and at home.
• 401K with company match.
• Comprehensive health and wellness packages.
• Internal mobility team dedicated to helping you own your career.
• Professional growth opportunities including paid education and certifications.
• Cutting-edge technology you can learn from.
• Rest and recharge with paid vacation and holidays .

#GDITFedHealthJobs#GDITWTCJobs

Work Requirements

Years of Experience

1 + years of related experience

* may vary based on technical training, certification(s), or degree

Certification

Travel Required

Less than 10%