Remote Claims Specialist II - Adjudication & Audit

Trillium Health Resources; North Carolina; Hybrid; USD 43,000 - 62,000; Full time

Benefits offered by this job

Health Insurance

Remote work options

Paid time off + holidays

401k with employer match

PSLF qualifying employer

Remote work stipend

Job summary

Trillium Health Resources seeks a Claims Specialist II to analyze and audit claims per NC Medicaid guidelines. The role supports providers by phone/email and collaborates with stakeholders to resolve claims efficiently. Strong knowledge of billing and coding, plus travel availability within NC, is expected.

The position offers remote work within North Carolina, standard hours, and benefits. A high school diploma with relevant experience is required; an Associate’s degree is preferred.

Qualifications

• High School Diploma or GED with 2 years in claims processing, billing or medical coding.
• Must reside in North Carolina and have a valid driver's license.
• Authorized to work in the United States without sponsorship now or in the future.
• Travel within catchment as required.
• Preferred: Associate’s degree in Healthcare Administration or related field.
• Certifications such as CPC/CPB/CMRS are a plus.

Responsibilities

• Analyze and audit claims adjudication results for NC Medicaid guidelines.
• Review attachments and medical documentation to adjudicate claims.
• Address delayed adjudication due to errors and take corrective actions.
• Identify provider and system errors and communicate with stakeholders.
• Ensure adherence to departmental policies and published rules.
• Provide training and technical assistance on claim submission and denial management.

Skills

Claims processing

Billing

Medical coding

Travel readiness

Education

High School Diploma or GED

Associate’s degree in Healthcare Administration or related field (preferred)

Job description

Trillium Health Resources seeks a Claims Specialist II to analyze and audit claims per NC Medicaid guidelines. The role supports providers by phone/email and collaborates with stakeholders to resolve claims efficiently. Strong knowledge of billing and coding, plus travel availability within NC, is expected.

The position offers remote work within North Carolina, standard hours, and benefits. A high school diploma with relevant experience is required; an Associate’s degree is preferred.