Member Services Processing Specialist

Clearance Level None Category SCA Location Remote, Working from the USA Key Skills For Success Collaboration Customer Problem Solving Customer Service Microsoft Applications Multitasking ##### **REQ\#:****RQ227591** ##### **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** ------------------- Job DescriptionThe 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