Healthcare Compliance Review Specialist
TEKsystems•Fairfield, CA
•$40 - $43•Hybrid
About The Position
Are you a detail-oriented professional who enjoys reviewing documentation, solving problems, and helping ensure fair and equitable access to healthcare services? We are seeking a Healthcare Compliance Review Specialist to join a respected healthcare organization committed to diversity, inclusion, and health equity. This is a fully remote opportunity following a 30-day onsite training period in Fairfield, CA, where you'll gain the knowledge and support needed to succeed in the role.
Requirements
- Strong analytical and organizational skills
- Typing Assessment (35–40 WPM required)
- Critical Thinking Assessment
Nice To Haves
- Experience in Appeals and grievances
- Experience in Compliance
- Experience in Case review
- Experience in Auditing
- Experience in Administrative support
- Experience in Quality assurance or documentation review
- Strong written and verbal communication skills
- Excellent attention to detail and organizational abilities
- Critical thinking and problem-solving skills
- Experience reviewing documents, policies, or case files
- Ability to work effectively with diverse populations and individuals from varying backgrounds
- Healthcare industry experience is preferred, but not required
Responsibilities
- Review member grievances and appeals to ensure compliance with company policies and regulatory requirements
- Investigate and analyze cases, including discrimination-related concerns, and help identify appropriate resolutions
- Review documentation and incoming member files for accuracy and completeness
- Evaluate the cultural and linguistic competency of subcontractors and recommend improvements where needed
- Monitor accreditation, contractual, legal, and regulatory requirements related to cultural and linguistic services
- Collaborate with internal teams to resolve member concerns in a timely manner
- Support health equity initiatives aimed at improving healthcare access and outcomes for diverse populations
- Maintain department records and files for auditing purposes
- Assist with training initiatives designed to promote cultural sensitivity and effective communication
- Perform data entry and other administrative responsibilities as needed
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
Job Type
Full-time
Career Level
Mid Level
Education Level
No Education Listed
