Claims Manager

🔥 0 minutes ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $70.3k - $94.7k / year

⏰ Full Time

🟢 Junior

👔 Manager

👻 Ghost score 0%

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Trillium Health Resources

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

🏥 Healthcare

💼 Consulting

📦 Logistics

Healthcare • Consulting • Logistics

Trillium Health Resources is a leading specialty care manager (LME/MCO) for individuals with serious behavioral health, intellectual/developmental disabilities, and traumatic brain injury in North Carolina. The organization is committed to investing in the health and well-being of the communities it serves, providing services such as preventive health screenings, crisis intervention, and tailored care management. Trillium focuses on enhancing access to mental health and substance use services for its members and ensuring support for vulnerable populations.

📋 Description

• Lead claims, analysis, and enrollment operations. • Be accountable for team performance, data integrity, and compliance. • Direct claims processing, reporting, and reimbursement activities. • Coordinate cross-functional efforts to support accurate claims payment and operational efficiency. • Manage day-to-day operations of claims, analysis, and enrollment teams. • Direct claims adjudication, reconciliation, auditing, and reporting activities. • Analyze claims data to identify trends, risks, and opportunities for improvement. • Oversee development and maintenance of reimbursement tables and procedures. • Manage staff performance, development, and accountability.

🎯 Requirements

• Associate's degree and three (3) years of experience with extensive claims filing and data reporting or eligibility and enrollment procedures; OR Bachelor's degree and one (1) year of experience with extensive claims filing and data reporting or eligibility and enrollment procedures; OR Equivalent combination of education and experience. • Must have a valid driver’s license. • Must reside within North Carolina. • Must be able to travel within catchment as required. • Preferred: Advanced degree • Preferred: Supervisory experience of two (2) or more employees • Preferred: Physical Health claims experience • All candidates must pass a drug test as a condition of employment.

🏖️ Benefits

• Collaborative, mission-driven work environment • Competitive benefits • Work-from-home options for most positions • Flexible work schedules for some roles with management approval • Health Insurance with no premium for employee coverage • Flexible Spending Accounts • 24 days of Paid Time Off (PTO) plus 12 paid holidays in your first year • NC Local Government Retirement Pension (defined-benefit plan) • 401k with 5% employer match and immediate vesting • Public Service Loan Forgiveness (PSLF) qualifying employer • Quarterly stipend for remote work supplies