Case Specialist

TEKsystems is seeking candidates to support a local healthcare organization in Hawaii. This role focuses on investigating, researching, and resolving member appeals, grievances, complaints, and complex service issues.

About the role

This is a fully on-site, contract position based in Honolulu, Hawaii. The schedule is Monday through Friday from 8:00 AM to 5:00 PM, with free parking provided.

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

Requirements

• 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

Pay

The pay range for this position is $23.33 - $23.33 per hour. Individual compensation offered within this range will depend on qualifications, skills, relevant experience, job knowledge, geographic location, internal equity, and other pertinent job-related factors.

Benefits

Eligibility requirements apply to some benefits and may depend on job classification and length of employment. Benefits are subject to change and may include the following for eligible employees:

• Medical, dental, and vision insurance
• Critical Illness, Accident, and Hospital coverage
• 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)