What are the responsibilities and job description for the Claims Specialist position at TEKsystems?
Description
The Claims Compliance Auditor is responsible for performing activities related to benefit analysis and system design, managing special projects, claim denials, and auto-adjudication applications, as it pertains to auditing and claims compliance. This includes oversight of all workflow, research, and documentation under limited supervision from Claims management. The incumbent identifies potential company risks, implements appropriate courses of action, and develops strategies to reduce adjudication errors. The role analyzes all relevant information to track and trend the outcomes of special projects, providing findings to the appropriate management. Case Follow Up and Tracking
HMO CLAIMS, Claim Denials, ezcap, Medicare Claims, CPT Codes, excel, Medicare Guidelines
Top Skills Details
HMO CLAIMS,Claim Denials,ezcap,Medicare Claims
Additional Skills & Qualifications
5 years working knowledge of claims processing and system configuration, preferably EZCap or like systems in the healthcare system , Strong ability to collaborate with management and other project managers to define business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery results . Review institutional claims with an authorization already attached to determine whether the existing auth could have been used to process the claim, then update EZ CAP. Review professional claims to validate whether the contract requires prior authorization. Prepare the case for denial back to the examiner when appropriate and update EZ CAP. Review claims with an attached authorization to confirm whether the auth is valid for processing, and update EZ CAP accordingly Review sensitive services claims Review Guardant cases by checking REA for an authorization. Process as an administrative denial, update EZ CAP.
Experience Level
Intermediate Level
Job Type & Location
This is a Contract position based out of Canoga Park, CA 91304.
Pay And Benefits
The pay range for this position is $26.00 - $26.00/hr.
Requirements
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
This is a fully onsite position in Canoga Park,CA 91304.
Application Deadline
This position is anticipated to close on May 18, 2026.
About TEKsystems
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems And TEKsystems Global Services
We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
The Claims Compliance Auditor is responsible for performing activities related to benefit analysis and system design, managing special projects, claim denials, and auto-adjudication applications, as it pertains to auditing and claims compliance. This includes oversight of all workflow, research, and documentation under limited supervision from Claims management. The incumbent identifies potential company risks, implements appropriate courses of action, and develops strategies to reduce adjudication errors. The role analyzes all relevant information to track and trend the outcomes of special projects, providing findings to the appropriate management. Case Follow Up and Tracking
- Follow up on cases sent to MDs and update EZ CAP. Current volume: 216 cases. Authorization Validation and Claim Review
- Review institutional claims with an authorization already attached to determine whether the existing auth could have been used to process the claim, then update EZ CAP.
- Review professional claims to validate whether the contract requires prior authorization. Prepare the case for denial back to the examiner when appropriate and update EZ CAP.
- Review claims with an attached authorization to confirm whether the auth is valid for processing, and update EZ CAP accordingly. Special Case and Sensitive Service Review
- Review sensitive services claims
- Review Guardant cases by checking REA for an authorization. Process as an administrative denial, update EZ CAP.
HMO CLAIMS, Claim Denials, ezcap, Medicare Claims, CPT Codes, excel, Medicare Guidelines
Top Skills Details
HMO CLAIMS,Claim Denials,ezcap,Medicare Claims
Additional Skills & Qualifications
5 years working knowledge of claims processing and system configuration, preferably EZCap or like systems in the healthcare system , Strong ability to collaborate with management and other project managers to define business process issues, analyze operational efficiencies, implement creative solutions, and measure delivery results . Review institutional claims with an authorization already attached to determine whether the existing auth could have been used to process the claim, then update EZ CAP. Review professional claims to validate whether the contract requires prior authorization. Prepare the case for denial back to the examiner when appropriate and update EZ CAP. Review claims with an attached authorization to confirm whether the auth is valid for processing, and update EZ CAP accordingly Review sensitive services claims Review Guardant cases by checking REA for an authorization. Process as an administrative denial, update EZ CAP.
Experience Level
Intermediate Level
Job Type & Location
This is a Contract position based out of Canoga Park, CA 91304.
Pay And Benefits
The pay range for this position is $26.00 - $26.00/hr.
Requirements
Eligibility requirements apply to some benefits and may depend on your job classification and length of employment. Benefits are subject to change and may be subject to specific elections, plan, or program terms. If eligible, the benefits available for this temporary role may include the following:
- Medical, dental & vision
- Critical Illness, Accident, and Hospital
- 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
- Life Insurance (Voluntary Life & AD&D for the employee and dependents)
- Short and long-term disability
- Health Spending Account (HSA)
- Transportation benefits
- Employee Assistance Program
- Time Off/Leave (PTO, Vacation or Sick Leave)
This is a fully onsite position in Canoga Park,CA 91304.
Application Deadline
This position is anticipated to close on May 18, 2026.
About TEKsystems
We're partners in transformation. We help clients activate ideas and solutions to take advantage of a new world of opportunity. We are a team of 80,000 strong, working with over 6,000 clients, including 80% of the Fortune 500, across North America, Europe and Asia. As an industry leader in Full-Stack Technology Services, Talent Services, and real-world application, we work with progressive leaders to drive change. That's the power of true partnership. TEKsystems is an Allegis Group company.
The company is an equal opportunity employer and will consider all applications without regards to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
About TEKsystems And TEKsystems Global Services
We’re a leading provider of business and technology services. We accelerate business transformation for our customers. Our expertise in strategy, design, execution and operations unlocks business value through a range of solutions. We’re a team of 80,000 strong, working with over 6,000 customers, including 80% of the Fortune 500 across North America, Europe and Asia, who partner with us for our scale, full-stack capabilities and speed. We’re strategic thinkers, hands-on collaborators, helping customers capitalize on change and master the momentum of technology. We’re building tomorrow by delivering business outcomes and making positive impacts in our global communities. TEKsystems and TEKsystems Global Services are Allegis Group companies. Learn more at TEKsystems.com.
The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
Salary : $26