Claims Examiner
TEKsystems•Los Angeles, CA
•$26 - $26•Onsite
About The Position
We are hiring a Claims Specialist to support claims compliance, authorization review, and auditing activities. This is a fully onsite role based in West Hills, CA. Note: An integrity assessment is required to move forward in the interview process.
Requirements
- 5+ years of experience in healthcare claims processing
- Working knowledge of EZ CAP or similar claims systems
- Strong understanding of authorizations, denials, and claims compliance
- Detail‑oriented with strong analytical and follow‑up skills
- Able to collaborate effectively with management and cross‑functional teams
Responsibilities
- Review institutional and professional claims to validate prior authorization requirements
- Confirm authorization accuracy and update EZ CAP accordingly
- Prepare cases for denial when appropriate and return to Claims Examiners
- Follow up on cases sent to Medical Directors and track updates in EZ CAP
- Review sensitive services and Guardant cases; process administrative denials as needed
- Track and trend findings from audits and special projects
Benefits
- 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)
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What This Job Offers
Career Level
Mid Level
Education Level
No Education Listed
Number of Employees
501-1,000 employees
