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T
TEKsystems
Case Specialist
Career Insights for Eligibility Specialist
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Scorecard
Based on Hawaii data
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What they do
An Eligibility Specialist provides assistance and information for people who apply for a government benefits program or health care program. Answers questions, assists with an application process, and reviews applications and relevant background information to determine eligibility. May assist eligible applicants with enrolling in a program.
$54,487 / year median in Hawaii
+20% projected growth
Job Description
Case Specialist TEKsystems - 3.8 Honolulu, HI Job Details Contract $23.33 an hour 17 hours ago Benefits Free parking Commuter assistance Health savings account AD&D insurance Disability insurance Health insurance Dental insurance 401(k) Paid time off Employee assistance program Vision insurance Life insurance Qualifications Phone communication Research Records management Customer interaction during outreach Client interaction via phone calls Full Job Description TEKsystems is seeking candidates who want to support a local healthcare organization in Hawaii. This role is responsible for investigating, researching, and resolving member appeals, grievances, complaints, and complex service issues. We are seeking candidates who are comfortable reviewing cases, conducting research, and taking the initiative to make outbound calls to members, providers, and internal business partners to gather information, provide updates, and help resolve issues. This is an on-site position located in Honolulu, Hawaii. The schedule is Monday through Friday from 8:00 AM to 5:00 PM, and free parking is provided. If you are interested in this opportunity, please apply, and one of our recruiters will reach out to discuss the position. Qualifications 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 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 Job Type & Location This is a Contract position based out of Honolulu, HI. Pay and Benefits The pay range for this position is $23.33 - $23.33/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 Honolulu,HI.