Member Services Senior Processor

This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Member Services Senior Processor based in India.

This role offers the opportunity to support complex member service operations within a large-scale federal healthcare <program.You>’ll take ownership of high-complexity applications, certifications, transfers, appeals, and documentation requiring careful review and sound <judgment.As> a senior operational specialist, you’ll serve as a key escalation point while helping junior processors resolve challenging cases.The position combines hands-on processing with quality assurance, workflow coordination, training, and continuous <improvement.You>’ll collaborate with supervisors, internal teams, and external stakeholders on sensitive and complex member matters.Your attention to detail and problem-solving skills will help maintain accurate, compliant, and efficient service <delivery.It>’s a strong opportunity for an experienced processor who enjoys mentoring others and contributing to operational excellence.

Accountabilities

• Process high-complexity applications, certifications, transfers, appeals, and supporting documentation requiring detailed analysis and interpretation.
• Serve as a lead processor for escalated cases and provide guidance and support to junior processing teams.
• Act as a primary escalation point for complex cases that can be resolved without direct supervisor intervention.
• Support supervisors with workflow coordination, workload assignments, operational priorities, and quality monitoring.
• Review completed work from less experienced processors to verify accuracy, completeness, and compliance with applicable policies and procedures.
• Provide constructive feedback and coaching to improve processing quality and individual performance.
• Train team members on program policies, procedures, systems, documentation requirements, and relevant regulatory considerations.
• Identify processing trends, recurring issues, and operational challenges while contributing to performance reporting and data collection.
• Communicate effectively with internal and external stakeholders regarding sensitive or complex processing matters.
• Support workflow optimization, system enhancements, process development, and continuous improvement initiatives.
• Assist with audit preparation, compliance reviews, documentation requirements, and operational readiness activities.
• Contribute to the development and implementation of improved processing practices and operational standards.

Requirements

• High school diploma or equivalent.
• 3–5 years of experience in processing, administrative support, operations, member services, or another high-volume service environment.
• Strong understanding of member processing workflows, documentation review, eligibility requirements, and regulatory considerations.
• Demonstrated ability to analyze complex documentation and process cases accurately and efficiently.
• Strong customer service, communication, problem-solving, and organizational skills.
• Ability to handle sensitive information professionally and communicate clearly with diverse stakeholders.
• Experience reviewing the work of others and providing constructive feedback or mentoring.
• Ability to work with limited supervision while supporting supervisors and taking ownership of complex operational matters.
• Proficiency with Microsoft applications and other digital tools used for documentation and workflow management.
• Experience with intelligent document processing solutions, member service portals, or customer support platforms is a plus.
• Familiarity with platforms such as ServiceNow or CXone is desirable.
• Previous experience supporting federal healthcare programs or healthcare operations is strongly preferred.
• Ability to work a full-time schedule of approximately 40 hours per week.
• Willingness to travel occasionally, with expected travel of less than 10%.

Benefits

• Estimated hourly compensation of approximately $20.40–$27.60, depending on experience, geographic location, and applicable contractual requirements.
• Flexible work arrangements designed to support work-life balance and allow employees to manage their priorities effectively.
• 401(k) retirement plan with employer matching.
• Comprehensive medical, dental, and vision coverage, with multiple healthcare plan options.
• Health Savings Account options available with eligible medical plans.
• Paid vacation, sick, personal time, and holidays.
• Paid parental, military, bereavement, and jury duty leave for eligible employees.
• Up to 160 hours of paid family leave during a rolling 12-month period for eligible employees.
• Short- and long-term disability coverage, life insurance, accidental death and dismemberment coverage, and other supplemental protection options.
• Professional development opportunities, including paid education and certifications.
• Internal career mobility support to help employees develop and progress professionally.
• Opportunities to work with modern technology and develop expertise in evolving digital tools and systems.
• Fully remote work opportunities with a flexible work structure.