Administrative Specialist (Healthcare) - Weekly Pay - Hiring Now!

TEKsystems•Honolulu, HI

9d•$22 - $23•Onsite

About The Position

The Case Resolution Specialist is responsible for assisting in the review, analysis, and resolution of member and provider appeals, inquiries, and grievances. This role supports organizational objectives by applying internal policies, contractual obligations, and regulatory requirements while delivering high-quality customer service. The specialist works collaboratively with supervisors, coordinators, and internal stakeholders to ensure timely, compliant, and member-focused resolutions.

Requirements

Strong customer service orientation with the ability to handle sensitive and complex situations professionally.
Effective verbal and written communication skills.
Problem identification, critical thinking, and resolution skills.
Ability to work in a call center or inbound customer support environment.
Basic proficiency in Microsoft Office applications, including Word, Excel, Outlook, and PowerPoint.
Strong attention to detail and ability to manage multiple cases efficiently.
Bachelor’s degree and one (1) year of related work experience; or an equivalent combination of education and experience.

Nice To Haves

Experience in the healthcare industry.
Experience in customer service or customer support roles.
Demonstrated ability to analyze information and make sound recommendations.

Responsibilities

Conduct detailed analysis of complex and sensitive member and provider appeals, inquiries, and grievances in accordance with internal policies, contractual provisions, and regulatory requirements.
Gather and evaluate facts from internal systems and external resources to develop a complete understanding of each case.
Prepare and present clear, thorough explanations of member or provider concerns, positions, and outcomes to supervisors and decision-makers.
Serve as a liaison between members, providers, and internal departments to support effective communication and resolution outcomes.
Identify recurring issues, trends, or member education needs and report findings to management, including recommendations for improvement.
Assist with the review and communication of new regulations, standards, or business changes impacting member advocacy and appeal processes.
Support coordination of process or policy changes across departments as directed by management.
Provide professional, empathetic customer service via inbound calls and written correspondence.