Appeals Specialist II

Trillium Health Resources; North Carolina; Hybrid; USD 56,000 - 70,000; Full time

Benefits offered by this job

Work-from-home options

Health Insurance with no employee-prem

Flexible Spending Accounts

PTO + holidays

401k with 5% employer match

PSLF qualification

Remote work stipend

Job summary

Trillium Health Resources is seeking an Appeals Specialist II to manage appeals and grievances from intake through resolution. You will investigate concerns, evaluate findings, and prepare determination communications to ensure accurate, timely resolution and regulatory compliance.

This exempt, full-time role offers remote work within North Carolina, a standard 8:30 am–5:00 pm schedule, and comprehensive benefits including health insurance, 401k with employer match, PSLF eligibility, and

Qualifications

• High school diploma or GED with 6 years of experience in mental health, developmental disabilities, or substance use services.
• OR an Associate's degree with 4 years of relevant experience.
• OR a Bachelor's degree with 2 years of relevant experience.
• Equivalent combination of education and experience.
• Must have a valid driver's license.
• Must reside within North Carolina.
• Must be legally authorized to work in the United States without sponsorship now or in the future.

Responsibilities

• Manage assigned appeals, grievances, and/or complaints from intake through resolution.
• Investigate cases by gathering documentation, interviewing stakeholders, and analyzing findings.
• Evaluate case information to determine appropriate resolution 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.

Education

High school diploma or GED

Associate's degree

Bachelor's degree

Job description

If you are unable to complete this application due to a disability, contact this employer to ask for an accommodation or an alternative application process.

Appeals and Grievances Full Time Professionals *Trillium office based location as specified below: US 2 Attachments

2 days ago Requisition ID: 3501

Salary Range: $56,270.00 To $69,898.00 Annually

Pay Plan Title: Appeals or Grievances Specialist II

FLSA Status: Exempt

Posting Salary Range: $56,270 - $69,898

Office Location: Remote within North Carolina

POSTING DETAILS

Make an Impact 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.

Why Work for Us?

Trillium believes that empowering others begins with supporting our team. We offer our employees:

• 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.

What We're Looking For

Trillium Health Resources has a career opening for an Appeals Specialist II to join our team! The Appeals Specialist II manages appeals or grievance cases from intake through resolution. The role investigates concerns, evaluates findings, and prepares determination communications to ensure accurate, timely resolution and compliance with regulatory and accreditation requirements.

On a typical day, you might:

• 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 resolution 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.

Employee Benefits

Trillium knows that work/life balance is essential. That's why we offer:

• 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
• 401k with 5% employer match and immediate vesting
• Public Service Loan Forgiveness (PSLF) qualifying employer
• Quarterly stipend for remote work supplies

Qualifications

• High school diploma or GED and six (6) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR
• Associate's degree and four (4) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR
• Bachelor's degree and two (2) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; 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.
• Must be legally authorized to work in the United States without requiring sponsorship for employment now or in the future (ex: OPT F-1, J-1).

Preferred

• Experience working with provider claims, provider network, or provider sanctions.

Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.

#Innovation #Technology #Careers #NorthCarolina #BehavioralHealth

Attachments (2)

Tips for Applying to or Interviewing with Trillium 10.9.26.pdf

GOVLC002 - Appeals or Grievances Specialist II.pdf