New

Claims Specialist

TEKsystems
$26.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, California, Canoga Park
Apr 18, 2026
Claims Compliance Auditor (Intermediate Level) Position Summary The Claims Compliance Auditor is responsible for performing benefit analysis, auditing activities, and claims compliance reviews to ensure accurate adjudication and adherence to regulatory, contractual, and organizational standards. This role supports special projects, claim denials, and auto-adjudication initiatives while identifying potential areas of risk and recommending corrective actions to reduce errors and improve operational outcomes. The incumbent works with limited supervision and provides audit findings, trends, and recommendations to Claims leadership. Key Responsibilities Case Follow-Up & Tracking * Follow up on cases escalated to Medical Directors (MDs) and accurately update EZCAP with disposition and status. * Track and manage a high-volume case load (current volume approximately 216 cases). Authorization Validation & Claim Review * Review institutional claims with attached authorizations to determine if the authorization is appropriate for claim processing; update EZCAP accordingly. * Review professional claims to confirm whether contract terms require prior authorization. * Prepare cases for denial and return to examiners when authorization requirements are not met. * Validate attached authorizations for accuracy, scope, and eligibility prior to claim adjudication. Special & Sensitive Claim Review * Review claims involving sensitive services in accordance with compliance guidelines. * Audit Guardant claims by verifying authorization in REA systems. * Process administrative denials when authorization is not present or invalid and document outcomes in EZCAP. Risk & Compliance Oversight * Identify patterns, trends, and potential compliance risks related to claims adjudication. * Analyze audit results and special project outcomes, providing documented findings to management. * Develop recommendations to reduce adjudication errors and improve compliance with Medicare guidelines, CPT coding standards, and payer requirements. Required Skills * HMO Claims Processing * Claims Denials & Appeals * EZCAP (or comparable claims systems) * Medicare Claims & Guidelines * CPT Coding Knowledge * Microsoft Excel Qualifications * Minimum of 5 years of hands-on experience in claims processing and claims system configuration within a healthcare environment. * Previous experience with EZCAP or similar claims adjudication platforms preferred. * Strong analytical and problem-solving skills with attention to detail. * Proven ability to collaborate effectively with management and cross-functional teams to evaluate business processes, improve operational efficiency, and implement solutions. Job Type & Location This is a Contract position based out of Canoga Park, CA 91304. Pay and BenefitsThe pay range for this position is $26.00 - $26.00/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 TypeThis is a fully onsite position in Canoga Park,CA 91304. Application DeadlineThis position is anticipated to close on May 1, 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.