Claims Specialist III
About The Position
Trillium Health Resources is hiring a Claims Specialist III to join its Claims team. This role manages and coordinates claims issues received from providers, members, or other entities by telephone, email, and ticket system. It provides support and information to the provider community by researching claims issues, gathering relevant information, and communicating resolutions or summaries. The specialist also tracks, reviews, and coordinates timely and accurate responses to inquiries, claims issues, and escalations submitted by the State Department. The position coordinates calls and tickets; keeps claims ticket queues and call logs current; researches claims using processing systems, previous and current support tickets, paper claim logs, claims staff, third-party biller information, Remittance Advice notifications, and provider technical assistance; assists with provider communications; and reviews issue trends to recommend updates to the Claims Processing System and staff training. The role is remote within North Carolina, requires residence in North Carolina, and may require travel within the catchment area.
Requirements
- High school diploma or GED and six years of experience managing deadlines, preparing and reviewing written correspondence, and maintaining records or conducting research in a healthcare or public health setting, including extensive medical claims research; or an associate's degree and four years of such experience; or a bachelor's degree and two years of such 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
- Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities.
- Experience in the public mental health field.
Responsibilities
- Manage and coordinate claims-related calls and tickets received from providers, members, and other entities.
- Keep claims ticket queues and call logs updated and ensure timely responses and notifications to providers about issue resolutions or summaries.
- Research claims issues using the claims processing system, Claims Support Queue tickets, paper claim logs, claims staff knowledge, third-party biller impacts, Remittance Advice notifications, and provider technical assistance.
- Gather information and communicate claims issue resolutions or summaries to the provider community.
- Track, review, and coordinate timely and accurate responses to inquiries, claims issues, and escalations submitted by the State Department.
- Assist with drafting provider-related communications.
- Review trends in provider issues and recommend updates to the Claims Processing System and Claims Staff training.
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.
- North Carolina Local Government Retirement Pension (defined-benefit plan).
- 401(k) with 5% employer match and immediate vesting.
- Public Service Loan Forgiveness qualifying employer.
- Quarterly stipend for remote work supplies.
- Work-from-home options for most positions.
- Flexible work schedules for some roles with management approval.
- Collaborative, mission-driven work environment and opportunities for professional growth in a diverse, inclusive culture.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Education Level
High school or GED
