Appeals Specialist II
About The Position
Trillium Health Resources is a Tailored Plan and Managed Care Organization serving 46 counties across North Carolina. It manages services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual and developmental disabilities. The Appeals Specialist II manages appeals or grievance cases from intake through resolution, investigating concerns, evaluating findings, and preparing determination communications to support accurate and timely resolutions and compliance with regulatory and accreditation requirements. The position is remote within North Carolina and may require travel within the catchment area.
Requirements
- High school diploma or GED and six years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; or an associate degree and four years of relevant experience; or a bachelor's degree and two years of relevant experience; or an equivalent combination of education and experience.
- Valid driver's license.
- Must reside within North Carolina.
- Must be able to travel within the catchment area as required.
- Must be legally authorized to work in the United States without requiring employment sponsorship now or in the future.
Nice To Haves
- Experience working with provider claims, provider networks, or provider sanctions.
Responsibilities
- Manage assigned appeals, grievances, and/or complaint cases from intake through resolution.
- Investigate cases by gathering documentation, interviewing stakeholders, and analyzing findings.
- Evaluate case information to determine appropriate resolutions and required actions.
- Prepare and issue acknowledgment and resolution letters within required time frames.
- Maintain complete case files in accordance with regulatory and accreditation standards.
Benefits
- Health insurance with no premium for employee coverage.
- Flexible Spending Accounts.
- 24 days of Paid Time Off plus 12 paid holidays in the first year.
- NC Local Government Retirement Pension (defined-benefit plan).
- 401(k) with 5% employer match and immediate vesting.
- Quarterly stipend for remote work supplies.
- Work-from-home options for most positions.
- Flexible work schedules for some roles with management approval.
- Public Service Loan Forgiveness qualifying employer.
Stand Out From the Crowd
Upload your resume and get instant feedback on how well it matches this job.
What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
