Claims Specialist III

🔥 18 hours ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $56.3k - $69.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

👻 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

• Manage and coordinate claim issues received by providers, members, or other entities via telephone, email, and ticket system • Provide support and information to the provider community • Research and gather information regarding claim issues • Relay resolutions and/or summaries of claim issues to providers • Track, review, and coordinate timely and accurate responses to inquiries, claims issues, and escalations submitted by the State Department • Coordinate and manage calls and tickets • Update and respond to claims ticket queues and call logs in a timely manner • Conduct claims research using claims processing systems, Claims Support Queue tickets, paper claim logs, claims staff input, third-party biller impacts, Remittance Advice notifications, and provider technical assistance • Assist with drafting provider-related communications • Review trends in provider issues and recommend updates to the Claims Processing System and Claims Staff training

🎯 Requirements

• High school diploma or GED and six (6) years of experience managing deadlines, preparing and reviewing written correspondence, and maintaining records or research in a healthcare or public health setting, including extensive medical claims research; OR Associate's degree and four (4) years of experience in the same areas; OR Bachelor's degree and two (2) years of experience in the same areas; OR Equivalent combination of education and experience. • Extensive medical claims research experience • Must have a valid driver's license • Must reside within North Carolina • Must be able to travel within catchment as required • Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities (preferred) • Experience in the public mental health field is highly desired • All candidates must pass a drug test as a condition of employment

🏖️ Benefits

• A collaborative, mission-driven work environment • Competitive benefits • Work-from-home options available for most positions • Opportunities for professional growth in a diverse inclusive culture • Flexible work schedules with some roles with management approval • Health Insurance with no premium for employee coverage • Flexible Spending Accounts • 24 days of Paid Time Off (PTO) • 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