New

Medical Claims Specialist

TEKsystems
$26.00 / hr
life insurance, sick time, 401(k), retirement plan
United States, California, Canoga Park
May 02, 2026
Job Title: Claims Compliance Auditor Job Description The Claims Compliance Auditor is responsible for performing audits and compliance reviews related to claims processing, benefit analysis, and authorization validation. This role supports claims management by overseeing workflow, conducting detailed claim reviews, managing special projects, and ensuring adherence to contractual, regulatory, and system requirements. The Auditor identifies potential compliance risks, recommends corrective actions, and develops strategies to reduce adjudication errors while tracking and reporting findings to leadership. Key Responsibilities Case Follow-Up and Tracking * Follow up on cases referred to physicians and update EZ-CAP accordingly * Manage and track a high volume of open cases * Ensure accurate documentation and timely resolution of assigned cases Authorization Validation and Claims Review * Review institutional claims with existing authorizations to determine if authorization could have been used to process the claim; update EZ-CAP accordingly * Review professional claims to validate whether prior authorization is required per contract * Prepare cases for denial and return to examiners when appropriate * Confirm the validity of attached authorizations for claim processing * Maintain accurate and compliant updates within EZ-CAP Special Case and Sensitive Service Review * Review sensitive services claims for compliance and authorization requirements * Review Guardant cases by researching authorization status within REA * Process administrative denials when appropriate and update EZ-CAP Compliance, Risk, and Reporting * Identify potential compliance and adjudication risks * Analyze outcomes of special projects and trending data * Provide findings, insights, and recommendations to claims management * Support continuous improvement initiatives related to claims accuracy and compliance Required Skills & Qualifications * Strong working knowledge of HMO claims processing * Experience with claim denials and authorization-driven adjudication * Proficiency with EZ-CAP (EZCAP) or similar claims systems * Knowledge of Medicare claims, CPT codes, and Medicare guidelines * Strong analytical, research, and documentation skills * Proficiency with Excel and data tracking tools Preferred Qualifications * Minimum of 5 years' experience in claims processing and system configuration within a healthcare environment * Experience collaborating with management and project stakeholders to identify business process issues, improve operational efficiency, and implement solutions * Ability to analyze workflows, measure outcomes, and support compliance-driven initiatives Experience Level * Intermediate Level Job Type & LocationThis 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 15, 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.