Job Title: Claims Compliance AuditorJob 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 ResponsibilitiesCase 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 & Location
This is a Contract position based out of Los Angeles, CA 91325.
Pay and Benefits
The 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 Type
This is a fully onsite position in Los Angeles,CA 91325.
Application Deadline
This position is anticipated to close on May 29, 2026.
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.
San Francisco Fair Chance Ordinance: Pursuant to the San Francisco Fair Chance Ordinance, for all positions located in the city and county of San Francisco, we will consider for employment qualified applicants with arrest and conviction records.
Massachusetts Lie Detector: It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.
Use of Artificial Intelligence (AI): We may use Artificial Intelligence (AI) to support parts of our hiring process, including sourcing, screening, and evaluating candidates. AI helps assess applications and qualifications, but final decisions are made by our hiring team. By applying, you acknowledge and agree that your application may be reviewed using AI tools.
