Claims Specialist III

Pay Plan Title: Claims Specialist III

Working Title: Claims Specialist III

FLSA Status: Exempt

Posting Salary Range: $56,270 - $69,898

Office Location: Remote within North Carolina
POSTING DETAILS:
Make an Impact

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

Why Work for Us ?

Trillium believes that empowering others begins with supporting our team. We offer our employees:

- A collaborative, mission-driven work environment

- Competitive benefits and work-from-home options for most positions

- Opportunities for professional growth in a diverse inclusive culture

Every day, our work changes lives – from children thriving through early intervention and school-based therapies, to adults with severe mental illness living independently and contributing to their communities.

If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today!
What We’re Looking For

Trillium Health Resources has a career opening for a Claims Specialist III to join our Claims team! The Claims Specialist III is responsible for managing and coordinating claim issues received by providers, members, or other entities via telephone call, email, and ticket system.The coordination of claim issues includes providing support and information to the provider community. This position will research and gather necessary information regarding claim issues and relay the resolution and/or summary of these issues to the provider community. The Claims Specialist III will also be responsible for tracking, reviewing, and coordinating timely and accurate responses that may include inquiries, claims issues, and escalations submitted by the State Department.
On a typical day, you might:

- Coordinate and manage calls and tickets.

- Ensure claims ticket queue and call logs are updated and responded to timely to allow for timely notifications to the provider community on the resolution and/or summary of their issues.

- Conduct claims research, including, but not limited to, review of claims processing system, review of previous and current tickets in the Claims Support Queue, review of paper claim logs, working with other claims staff to learn history, third party biller impacts, Remittance Advice notifications and provider technical assistance.

- Assist with drafting provider related communications.

- Review trends of provider issues and make recommendations for updates needed in the Claims Processing System and Claims Staff training.

Employee Benefits:

Trillium knows that work/life balance is essential. That’s why we offer:

- Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval.

- Work-from-home options available for most positions

- 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

Qualifications
Required:

- 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 managing deadlines, preparing and reviewing written correspondence, and maintaining records or research in a healthcare or public health setting, including extensive m