Grievance & Appeals Auditor

TEKsystems; Fairfield (CA); On-site; USD 59,000 - 62,000; Full time

Benefits offered by this job

Medical, dental & vision

401(k) Plan

Pre-tax & Roth

Life Insurance

Disability insurance

Health Savings Account

Transportation benefits

Employee Assistance Program

Time Off

Job summary

TEKsystems is seeking a Grievance & Appeals Auditor for an onsite contract role in Fairfield, CA (also listed with Redding, CA). You will review grievance and appeal cases for accuracy, quality, and regulatory compliance, ensuring documentation and timelines are met.

Ideal candidates bring strong analytical skills, attention to detail, and experience in healthcare auditing, with proficiency in MS Office and the ability to work independently in a fast-paced environment.

Qualifications

• Strong attention to detail and analytical skills.
• Experience reviewing, auditing, investigating, or evaluating documentation.
• Excellent written and verbal communication skills.
• Ability to identify discrepancies and compliance concerns.
• Strong organizational and time-management skills.
• Ability to work independently and manage multiple priorities.
• Experience in healthcare, health insurance, managed care, compliance, auditing, quality assurance, grievances & appeals, claims, or regulatory operations preferred.
• Proficiency with Microsoft Office, including Word, Excel, and Outlook.

Responsibilities

• Review grievance and appeal cases for accuracy, completeness, and compliance.
• Audit case files to ensure required processes and procedures were followed.
• Verify that appropriate documentation and supporting evidence were collected during investigations.
• Review case notes, correspondence, investigation findings, and final determinations.
• Ensure cases are completed within required regulatory timelines.
• Identify documentation gaps, procedural errors, inconsistencies, and compliance concerns.
• Document audit findings and communicate recommendations to leadership.
• Review cases against internal policies, procedures, and regulatory requirements, including DHCS guidelines.
• Monitor trends and identify recurring quality or compliance issues.
• Help promote consistency and best practices across the Grievance & Appeals department.
• Maintain knowledge of applicable healthcare regulations, policies, and compliance standards.

Skills

Attention to detail

Analytical skills

Written and verbal communication

Discrepancy identification

Organizational and time-management

Independent work / multi-priority

Healthcare/audit/regulatory experience

Microsoft Office Suite

Tools

Microsoft Office Suite

Job description

Grievance & Appeals Auditor

Fairfield, CA or Redding, CA (100% Onsite)

$43-$45/hour

Monday-Friday | 8:00 AM - 5:00 PM

Position Overview

We are seeking a Grievance & Appeals Auditor to review grievance and appeal cases for accuracy, quality, and compliance. This role is ideal for someone with strong analytical skills who enjoys reviewing documentation, identifying discrepancies, and ensuring processes are followed correctly.

The Auditor serves as a quality assurance resource for the Grievance & Appeals team by evaluating completed case investigations and confirming that cases are properly documented, compliant with regulatory requirements, and resolved within required timelines.

Responsibilities

• Review grievance and appeal cases for accuracy, completeness, and compliance.
• Audit case files to ensure required processes and procedures were followed.
• Verify that appropriate documentation and supporting evidence were collected during investigations.
• Review case notes, correspondence, investigation findings, and final determinations.
• Ensure cases are completed within required regulatory timelines.
• Identify documentation gaps, procedural errors, inconsistencies, and compliance concerns.
• Document audit findings and communicate recommendations to leadership.
• Review cases against internal policies, procedures, and regulatory requirements, including DHCS guidelines.
• Monitor trends and identify recurring quality or compliance issues.
• Help promote consistency and best practices across the Grievance & Appeals department.
• Maintain knowledge of applicable healthcare regulations, policies, and compliance standards.

Qualifications

• Strong attention to detail and analytical skills.
• Experience reviewing, auditing, investigating, or evaluating documentation.
• Excellent written and verbal communication skills.
• Ability to identify discrepancies and compliance concerns.
• Strong organizational and time-management skills.
• Ability to work independently and manage multiple priorities.
• Experience in healthcare, health insurance, managed care, compliance, auditing, quality assurance, grievances & appeals, claims, or regulatory operations preferred.
• Proficiency with Microsoft Office, including Word, Excel, and Outlook.

Required Assessment

Candidates selected to move forward in the process will be required to complete:

• An Auditor Assessment (evaluates auditing, analytical thinking, compliance knowledge, and attention to detail). The assessment must be completed within one hour of receipt.

If you're passionate about quality, compliance, and process improvement, this is a great opportunity to help ensure members receive fair, accurate, and compliant grievance and appeal resolutions while supporting a leading healthcare organization.

Job Type & Location

This is a Contract position based out of Fairfield, CA.

Pay and Benefits

The pay range for this position is $43.00 - $45.00/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)

Workplace Type

This is a fully onsite position in Fairfield,CA.

Application Deadline

This position is anticipated to close on Oct 8, 2026.

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.

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.