Healthcare TPA Member Services Processing Analyst

Clearance Level

None

REQ#: RQ223955

Public Trust: MBI (T2)

Requisition Type: Regular

Your Impact

Own your opportunity to work alongside federal civilian agencies. Make an impact by providing services that help the government ensure the well being and support of U.S. citizens.

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

Work Requirements

Years of Experience

5 + years of related experience

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

Certification

Travel Required

Less than 10%

Salary and Benefit Information

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.
View information about benefits and our total rewards program.

Our Identity 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.

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Equal Opportunity Employer / Individuals with Disabilities / Protected Veterans