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 Canada. 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. How Jobgether Works We use an AI-powered matching process to ensure your application is reviewed quickly, objectively, and fairly against the role's core requirements. Our system identifies the top-fitting candidates, and this shortlist is then shared directly with the hiring company. The final decision and next steps (interviews, assessments) are managed by their internal team. We appreciate your interest and wish you the best! Why Apply Through Jobgether? Data Privacy Notice: By submitting your application, you acknowledge that Jobgether will process your personal data to evaluate your candidacy and share relevant information with the hiring employer. This processing is based on legitimate interest and pre-contractual measures under applicable data protection laws (including GDPR). You may exercise your rights (access, rectification, erasure, objection) at any time. We may use artificial intelligence (AI) tools to support parts of the hiring process, such as reviewing applications, analyzing resumes, or assessing responses and identifying potential inconsistencies or verification signals in application materials based on available information. These tools assist our recruitment team but do not replace human judgment. Final hiring decisions are ultimately made by humans. If you would like more information about how your data is processed, please contact us.

Process high-complexity member applications, certifications, and appeals while serving as a lead escalation point for junior staff. Coordinate workflows, perform quality monitoring, and contribute to continuous process improvement initiatives.

Requires a high school diploma and 3-5 years of experience in processing, operations, or member services. Candidates should be proficient in Microsoft applications and have a strong ability to analyze complex documentation within a high-volume environment.

• 401(k) retirement plan with employer matching • Medical coverage • Dental coverage • Vision coverage • Health Savings Account options • Paid vacation • Sick time • Personal time • Paid holidays • Paid parental leave • Paid military leave • Paid bereavement leave • Paid jury duty leave • Paid family leave • Short-term disability coverage • Long-term disability coverage • Life insurance • Accidental death and dismemberment coverage • Professional development opportunities • Paid education and certifications • Internal career mobility support • Fully remote work opportunities

• Service à la clientèleSouhaitée
• Résolution de problèmesSouhaitée
• Assurance qualitéSouhaitée
• Microsoft OfficeSouhaitée

Relevées dans la description du poste. Confirmez les exigences importantes ci-dessus.

• Case Processing
• Quality Assurance
• Workflow Coordination
• Mentoring
• Documentation Review
• Problem Solving
• Customer Service
• Regulatory Compliance
• Microsoft Office
• Stakeholder Communication
• Data Collection
• Audit Preparation

• Healthcare
• Customer Service & Support
• Administrative
• Management & Leadership
• Government & Public Sector

Formation minimale

Études secondaires

Expérience minimale

2+ ans

Langue de l’offre

anglais

Heures de travail

40 heures par semaine

Niveau d’expérience

Mid-Senior level

Mode de candidature

La candidature directe est offerte