What are the responsibilities and job description for the Utilization Review Specialist position at TEKsystems?
*Job Title**: *Retro Claims Reviewer
*Location**: *West Hills/Canoga Park 91305
*Compensation**:*
LVN $38-$40 hourly
RN $45-$50 hourly
*Overview**:*
The Retro Claims Reviewer is responsible for auditing and reviewing medical claims to ensure accuracy, regulatory compliance, and proper adjudication. This
role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes.
*Key Responsibilities:*
* Audit denied provider and member claims for accuracy and compliance
* Review and process claims in accordance with UM guidelines and regulatory standards
* Analyze benefit structures and system configurations (EZCap or similar)
* Collaborate with cross-functional teams to resolve claim issues and process gaps
* Document findings, prepare reports, and present trends to leadership
* Support automated adjudication systems and identify strategies to reduce errors
* Ensure HIPAA and PHI compliance throughout all claim review activities
* Participate in special projects related to claim denials and appeals
*Required Qualifications:*
* Active LVN or RN license (California)
* 2 years of experience in Utilization Management (UM)
* Hands-on experience with HMO/Medicare claims, audits, and denials
* Familiarity with claims processing systems (EZCap or similar)
* Strong analytical, documentation, and communication skills
* Ability to work independently and prioritize tasks
* Proficiency in MS Office Suite (Excel, Access, PowerPoint, Word)
*Preferred Skills:*
* CPT, HCPCS, ICD-10 coding knowledge
* Advanced Excel skills
* Experience with regulatory agencies and compliance audits
*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 $35.00 - $50.00/hr.
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)
*Workplace Type*This is a hybrid position in Canoga Park,CA 91304.
*Application Deadline*This position is anticipated to close on Jan 12, 2026.
h4>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.
*Location**: *West Hills/Canoga Park 91305
*Compensation**:*
LVN $38-$40 hourly
RN $45-$50 hourly
*Overview**:*
The Retro Claims Reviewer is responsible for auditing and reviewing medical claims to ensure accuracy, regulatory compliance, and proper adjudication. This
role is ideal for a Licensed Vocational Nurse (LVN) or Registered Nurse (RN) with hands-on experience in Utilization Management (UM) and a strong understanding of HMO/Medicare claims processes.
*Key Responsibilities:*
* Audit denied provider and member claims for accuracy and compliance
* Review and process claims in accordance with UM guidelines and regulatory standards
* Analyze benefit structures and system configurations (EZCap or similar)
* Collaborate with cross-functional teams to resolve claim issues and process gaps
* Document findings, prepare reports, and present trends to leadership
* Support automated adjudication systems and identify strategies to reduce errors
* Ensure HIPAA and PHI compliance throughout all claim review activities
* Participate in special projects related to claim denials and appeals
*Required Qualifications:*
* Active LVN or RN license (California)
* 2 years of experience in Utilization Management (UM)
* Hands-on experience with HMO/Medicare claims, audits, and denials
* Familiarity with claims processing systems (EZCap or similar)
* Strong analytical, documentation, and communication skills
* Ability to work independently and prioritize tasks
* Proficiency in MS Office Suite (Excel, Access, PowerPoint, Word)
*Preferred Skills:*
* CPT, HCPCS, ICD-10 coding knowledge
* Advanced Excel skills
* Experience with regulatory agencies and compliance audits
*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 $35.00 - $50.00/hr.
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)
*Workplace Type*This is a hybrid position in Canoga Park,CA 91304.
*Application Deadline*This position is anticipated to close on Jan 12, 2026.
h4>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.
Salary : $35 - $50