Claims Specialist III

Claims Specialist III

Office Location:

Remote within North Carolina.

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.

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

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.

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.

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.

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

Quarterly stipend for remote work supplies

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;

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 medical claims research;

Bachelor's degree and two (2) 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;

Must be able to travel within catchment as required.

Experience in the public mental health field is highly desired due to the complexity of the work of organization.

Deadline for Application:

To be considered, submit your application and resume through our ADP Career Center. Education details (degree type, date awarded, institution, field of study)

You’ll be notified by HR regarding your application status as appropriate. Join our Talent Community through ADP to stay informed about future opportunities.