Grievance & Appeals Quality Auditor - Onsite

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

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.