Healthcare TPA Member Services Processing Analyst

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.

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.

Skills

• Continuous Improvement
• Core Competencies
• Leadership

Benefits

• Full-flex work week
• 401K with company match
• Comprehensive health and wellness packages
• Internal mobility team
• Professional growth opportunities including paid education and certifications
• Cutting-edge technology

Pay

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.

Schedule

Full-time schedule