Claims Specialist III

🔥 1 minute ago

🌲 North Carolina – Remote

🌲 North Carolina – Remote

💵 $56.3k - $69.9k / year

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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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 from providers, members, or other entities via telephone, email, and ticket system • Provide support and information to the provider community • Research and gather necessary information regarding claim issues • Relay resolutions and/or issue summaries to the provider community • 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 the claims ticket queue and call logs • Conduct claims research using the claims processing system, Claims Support Queue, paper claim logs, claims staff history, 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 such experience; OR Bachelor's degree and two (2) years of such experience; OR equivalent combination of education and experience • Extensive medical claims research experience • Valid driver’s license • Must reside within North Carolina • Must be able to travel within catchment as required • Preferred degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities • Experience in the public mental health field highly desired • Must pass a drug test as a condition of employment

🏖️ Benefits

• Competitive benefits • Work-from-home options for most positions • Flexible work schedules with management approval for some roles • Health Insurance with no premium for employee coverage • Flexible Spending Accounts • 24 days of Paid Time Off (PTO) • 12 paid holidays in the 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