Claims Specialist III
Pay Plan Title: Claims Specialist III
FLSA Status: Exempt
Posting Salary Range: $56,270 - $69,898
Office Location: Remote within North Carolina
About the role
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 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.
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.
Why Work for Us
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
- 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.
Benefits
Trillium knows that work/life balance is essential. That's why we offer:
- Comprehensive employee benefits (details not specified in the posting)