Claims Operations Specialist

TEKsystems is seeking a Claims Specialist to support a leading healthcare payer organization in Hawaii. This role focuses on supporting end-to-end claims processing operations, ensuring accurate and timely adjudication, and contributing to process improvements across workflows. This is a great opportunity for someone with strong healthcare claims experience who wants to play a key role in improving operational efficiency and service quality. This person should be in Oahu and able to work hybrid. Responsibilities Support daily claims processing activities including intake, adjudication, adjustments, and issue resolution Ensure claims are processed accurately, efficiently, and in compliance with regulatory and internal guidelines Monitor claims-related metrics such as turnaround time, accuracy, and backlog Assist with investigating and resolving complex or escalated claims issues Identify inefficiencies in claims workflows and recommend improvements Partner with internal teams to streamline processes and reduce manual work Support system enhancements, automation efforts, and operational improvement initiatives Collaborate with third-party vendors supporting claims processing Monitor vendor output and elevate issues as needed Work cross-functionally with teams such as Provider Relations, Customer Service, Compliance, and IT Assist with audits, compliance reviews, and reporting activities Contribute to initiatives that improve overall member and provider experience Qualifications Experience in healthcare claims operations Strong understanding of claims workflows and adjudication processes Knowledge of medical billing, coding basics (ICD, CPT, HCPCS), and reimbursement concepts Ability to analyze processes and identify improvements Strong attention to detail and organizational skills Experience with provider claims processing Exposure to vendor-supported or outsourced claims environments Strong analytical and problem-solving skills Effective communication and collaboration across teams Ability to prioritize and manage multiple tasks in a fast-paced environment Detail-oriented with a focus on accuracy and quality Job Type & Location This is a Contract position based out of Honolulu, HI. Pay and Benefits The pay range for this position is $30.00 - $32.00/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. 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 hybrid position in Honolulu, HI. Application Deadline This position is anticipated to close on Jun 12, 2026. 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. #J-18808-Ljbffr TEKsystems