Claims Specialist III

TRILLIUM HEALTH RESOURCES•Remote in North Carolina, NC, US, NC

3d•$56,270 - $69,898•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/development (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. We offer our employees a collaborative, mission-driven work environment, competitive benefits and work-from-home options for most positions, and 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. 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.

Requirements

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 medical claims research; OR 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; OR Equivalent combination of education and 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

Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities.
Experience in the public mental health field is highly desired due to the complexity of the work of organization.

Responsibilities

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.