Claims Manager

Trillium Health Resources; North Carolina; Hybrid; USD 67,632 - 90,457; Full time

Benefits offered by this job

Health Insurance with no premium

Flexible Spending Accounts

401k with employer match

24 days of Paid Time Off

Quarterly stipend for remote work supplies

Job summary

A nonprofit managed care organization in North Carolina is seeking a Claims Manager to oversee claims processing and enhance team performance. This role involves analyzing claims payment reports, developing procedures, and addressing issues within the provider community. A successful candidate will have strong experience in claims filing and data reporting along with leadership qualities. This position offers flexible work options and significant employee benefits, including health insurance and a generous PTO policy.

Qualifications

• 3+ years of experience in claims filing and data reporting if holding an Associate's degree.
• Minimum of 1 year of experience in claims if holding a Bachelor's degree.
• Valid driver's license and residence in North Carolina.

Responsibilities

• Generate and analyze claims payment reports.
• Develop and maintain claim processing procedures.
• Train and mentor claims processing staff.

Skills

Claims filing

Data reporting

Problem-solving

Team leadership

Education

Associate's degree

Bachelor's degree

Job description

Claims Manager

Location: Remote within North Carolina. FLSA Status: Exempt. Cost Center: 4300/Claims. Position Number: 80744.

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/developmental (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

Base Pay Range

$67,632.00/yr - $90,457.00/yr

Key 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.

Employee Benefits

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

Qualifications

Required:

• 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.

Preferred:

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

How to Apply

To be considered, submit your application and resume through our ADP Career Center. Your resume must include:

• Employer name, dates of service (month/year), average hours worked per week, and essential job duties.
• Education details (degree type, date awarded, institution, field of study).
• Licensure/certification information, if applicable.

After submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes.

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.