Processing Specialist I - Special Processing (Remote)
Core
HR operations specialist managing complex benefit processing, compliance, and member services including appeals, condolences, and Medicare requests.
Role type
mid-level HR operations specialist
Builds
accurate benefit claims, compliance documentation, and member support workflows
Domain
Human Resources / Benefits Administration
Required skills
benefits processing, compliance management, HRIS proficiency, claims submission, eligibility verification, documentation management, regulatory knowledge (HIPAA/IRS/CMS), data protection
Preferred skills
Human Resources degree, 2-3 years HR operations experience, Microsoft Office proficiency, critical thinking, process improvement
Responsibilities
Review and process appeals, condolences, QMCSO orders, Medicare L-564 forms, and POA requests; Verify eligibility and manage elections, record updates, and coverage activation; Submit life and disability claims timely; Apply client-specific requirements across multiple workstreams; Provide proactive, accurate, and empathetic support to enhance member experience; Maintain compliance with HIPAA, IRS, CMS regulations and manage mandated notices and documentation; Identify and resolve documentation or process issues using critical thinking and compliance standards; Protect sensitive data and maintain transaction integrity; Handle escalations, assist during client calls, and prepare activity and performance reports; Participate in daily stand-ups and foster team collaboration.
