Claims Manager

TRILLIUM HEALTH RESOURCES

2h•Remote

About The Position

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/developmental (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives. Trillium believes that empowering others begins with supporting our team, offering a collaborative, mission-driven work environment, competitive benefits, work-from-home options for most positions, and opportunities for professional growth in a diverse, inclusive culture. Every day, our work changes lives. The Claims Manager is responsible for ensuring accurate processing of all claims, the appropriate data elements required to process claims accurately, and reporting and analysis of claims data, including responding to claim appeals. This position will work closely with the Claims Processing Supervisors and Claims Processing Assistants to resolve provider-related issues related to claims submissions and payments in a timely manner. This position will also work closely with the Fiscal Analyst Manager to resolve claim issues and with Trillium’s Appeals Team on claim appeals.

Requirements

Associate’s degree and three (3) years of experience with extensive claims filing and data reporting; OR Bachelor’s degree and a minimum of one (1) year of experience with extensive claims filing and data reporting; OR Equivalent combination of education/experience.
Must have a valid driver’s license.
Must reside within North Carolina.
Must be able to travel within catchment as required.

Nice To Haves

Advanced degree preferred.
Supervisory experience of two (2) or more employees
Physical Health claims experience

Responsibilities

Ensure claims payment reports are generated and analyzed to determine problems.
Ensure analysis, research, and corrections are completed in a timely manner to ensure provider payment.
Assist in developing and maintaining claim processing procedures and ensuring these procedures are understood and followed by claims staff.
Interact with the provider community to address billing issues.
Train and mentor staff on claims processing duties to enhance team performance.

Benefits

A collaborative, mission-driven work environment
Competitive benefits
work-from-home options for most positions
Opportunities for professional growth in a diverse, inclusive culture
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