Healthcare TPA Member Services Processing Analyst

Type of Requisition:

Regular

Clearance Level Must Currently Possess:

None

Clearance Level Must Be Able to Obtain:

None

Public Trust/Other Required:

MBI (T2)

Job Family:

Process and Operational Efficiency

Job Qualifications:

Skills:

Continuous Improvement, Core Competencies, Leadership

Certifications:

None

Experience:

5 + years of related experience

US Citizenship Required:

No

Job Description:

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.

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

The likely hourly rate for this position is between $55,250.00 - $74,750.00. This is not, however, a guarantee of compensation or salary. Rather, salary will be set based on experience, geographic location and possibly contractual requirements and could fall outside of this range.

Scheduled Weekly Hours:

40

Travel Required:

Less than 10%

Telecommuting Options:

Remote

Work Location:

Any Location / Remote

Additional Work Locations:

Total Rewards at GDIT:

Our benefits package for all US-based employees includes a variety of medical plan options, some with Health Savings Accounts, dental plan options, a vision plan, and a 401(k) plan offering the ability to contribute both pre and post-tax dollars up to the IRS annual limits and receive a company match. To encourage work/life balance, GDIT offers employees full flex work weeks where possible and a variety of paid time off plans, including vacation, sick and personal time, holidays, paid parental, military, bereavement and jury duty leave. GDIT typically provides new employees with 15 days of paid leave per calendar year to be used for vacations, personal business, and illness and an additional 10 paid holidays per year. Paid leave and paid holidays are prorated based on the employee’s date of hire. The GDIT Paid Family Leave program provides a total of up to 160 hours of paid leave in a rolling 12 month period for eligible employees. To ensure our employees are able to protect their income, other offerings such as short and long-term disability benefits, life, accidental death and dismemberment, personal accident, critical illness and business travel and accident insurance are provided or available. We regularly review our Total Rewards package to ensure our offerings are competitive and reflect what our employees have told us they value most.

Our Identify Verification Process:

As part of the hiring process, we will ask you to complete an identity verification process that leverages advanced biometrics and artificial intelligence to ensure authenticity and protect against identity fraud. You are expected to be on camera during virtual interviews. We reserve the right to take your picture to verify your identity and prevent fraud. By proceeding, you authorize the collection, processing, and use of your biometric data for identity verification and security purposes.

 

 

About our Work:

We are GDIT. A global technology and professional services company that delivers technology solutions and mission services to every major agency across the U.S. government, defense and intelligence community. Our 26,000 experts extract the power of technology to create immediate value and deliver solutions at the edge of innovation. We operate across 50+ countries worldwide, offering leading mission-ready capabilities in AI, cloud, cyber and software development.

Join our Talent Community to stay up to date on our career opportunities and events at

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans