Utilization Management Specialist

Hybrid Schedule - 3 days remote and 2 on-site (Tues/Thurs). M-F 8am - 5pm. *Position Overview* The Utilization Management Specialist plays a critical role within the Quality Management department, serving as the last line of defense for claims that have been denied. This position is responsible for researching denied claims, gathering necessary information, and facilitating resubmission to Health Plans. The ideal candidate will possess strong verbal and written communication skills and be comfortable interacting with Doctor Offices, Health Plans, and Medical Directors throughout the appeals process.
*Key Responsibilities*
* Research and review denied claims to ensure accuracy and completeness prior to resubmission.
* Communicate directly with healthcare providers, Health Plans, and Medical Directors to obtain required documentation and information for appeals.
* Complete and process tasks related to claims support, prior authorizations, and appeals.
* Maintain compliance with internal policies and regulatory requirements.
* Perform data entry and utilize EMR/EHR systems to document findings and actions.
* Support quality improvement initiatives and contribute to departmental goals.
*Required Skills & Qualifications*
* Minimum 1 year of experience as a Medical Assistant (required).
* Experience in quality improvement, patient care, claims processing, and prior authorization.
* Proficiency with EMR/EHR systems and data entry.
* Excellent verbal and written communication skills.
* Self-motivated, organized, and computer savvy.
* Strong research and letter writing abilities.
* Ability to work independently and collaboratively in a fast-paced environment.
*Preferred Skills*
* Experience in ambulatory and healthcare settings.
* Familiarity with claims support and appeals processes.
* Demonstrated ability to manage multiple priorities and deadlines.
*Pay and Benefits*
The pay range for this position is $21.00 - $23.00/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 hybrid position in Los Angeles,CA 91325.
*Application Deadline*
This position is anticipated to close on Oct 26, 2025.
h4>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.