Remote Claims Specialist II — Data & Adjudication

Trillium Health Resources; Clayton (NC); Remote; USD 43,000 - 62,000; Full time

Benefits offered by this job

Health insurance

Remote work options

PTO & holidays

401k matching

Job summary

Trillium Health Resources is seeking a Claims Specialist II to analyze, audit, and finalize adjudication results for NC Medicaid claims, using CMS guidelines and internal policies. You will assist providers via phone or email and coordinate with internal and external stakeholders for timely resolutions.

The role emphasizes data-driven decision making, claims education, and support across the NC catchment. Remote work within NC is available with standard hours and benefits.

Qualifications

• High School Diploma or GED with 2 years in claims processing or related field.
• Valid driver's license and NC residency.
• Eligible to work in the United States without sponsorship.

Responsibilities

• Analyze and audit claims adjudication results to determine accuracy per NC Medicaid guidelines.
• Audit claim attachments/medical documentation to adjudicate claims.
• Audit and act on claims delayed for adjudication due to errors.
• Identify adjudication errors and provider billing issues.
• Review trainings and CMS guidelines to ensure compliance.
• Provide training and technical assistance to providers on submission guidelines.
• Report system issues to supervisor based on data analysis.

Skills

Data analysis

Auditing

Claims processing

Provider support

Policy knowledge

Education

High School Diploma or GED

Associates degree (preferred)

Tools

Billing software

Job description

Trillium Health Resources is seeking a Claims Specialist II to analyze, audit, and finalize adjudication results for NC Medicaid claims, using CMS guidelines and internal policies. You will assist providers via phone or email and coordinate with internal and external stakeholders for timely resolutions.

The role emphasizes data-driven decision making, claims education, and support across the NC catchment. Remote work within NC is available with standard hours and benefits.