Claims Specialist

Job Description

Job Description

TEKsystems is seeking candidates who want to support a local healthcare organization in Hawaii. This role is responsible for investigating, researching, and resolving member appeals, grievances, complaints, and complex service issues. We are seeking candidates who are comfortable reviewing cases, conducting research, and taking the initiative to make outbound calls to members, providers, and internal business partners to gather information, provide updates, and help resolve issues. This is an on-site position located in Honolulu, Hawaii. The schedule is Monday through Friday from 8:00 AM to 5:00 PM, and free parking is provided. If you are interested in this opportunity, please apply, and one of our recruiters will reach out to discuss the position.

Qualifications

• Ability to work on-site five (5) days per week in Honolulu, Hawaii
• Available to work Monday through Friday from 8:00 AM to 5:00 PM
• Ability and willingness to make outbound phone calls to members, providers, and internal business partners to gather information, resolve issues, and provide case updates
• Strong critical thinking, problem-solving, and investigative skills
• Ability to research complex issues and analyze information from multiple sources
• Excellent written and verbal communication skills
• Strong organizational skills and attention to detail
• Experience documenting and maintaining accurate case records
• Ability to manage sensitive situations with professionalism and empathy
• Experience with case management systems is preferred

Responsibilities

• Investigate member appeals, grievances, complaints, and escalated service issues
• Review claims, authorizations, benefits, policies, correspondence, and member histories to determine root causes and appropriate resolutions
• Research plan benefits, contractual language, and regulatory requirements related to member concerns
• Gather and analyze information from internal departments including Claims, Customer Service, Clinical Operations, Provider Services, Care Management, and Pharmacy
• Manage assigned cases from initial review through final resolution
• Analyze findings and determine appropriate outcomes based on policies, evidence, and regulatory requirements
• Draft case findings, resolution summaries, and member communications
• Conduct outreach to members, authorized representatives, and providers to obtain information and provide updates
• Explain appeal and grievance processes in a professional and easy-to-understand manner
• Maintain detailed case notes, investigation records, and supporting documentation within the case management system
• Ensure all case activities meet regulatory requirements, organizational standards, and required turnaround times
• Escalate high-risk, sensitive, or complex cases when necessary
• Track case outcomes, identify trends, and recommend process improvements
• Support audits, quality reviews, regulatory reporting activities, and continuous improvement initiatives
• Collaborate with internal business partners to coordinate resolutions and improve the member experience

This is a Contract position based out of Honolulu, HI.

The pay range for this position is $23.33 - $23.33/hr.

Individual compensation offered for this position within this range will depend on many factors, including qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

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)

This is a fully onsite position in Honolulu,HI.

This position is anticipated to close on Aug 28, 2026.

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.

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.