Remote Claims Specialist III - Provider Support & Impact

Trillium Health Resources; Raleigh (NC); Remote; USD 56,000 - 70,000; Full time

Benefits offered by this job

Health Insurance

Flexible Spending Accounts

PTO 24 days + 12 holidays

NC Retirement Pension (LGERS)

401k with 5% employer match

Public Service Loan Forgiveness (PSLF)

Remote work stipend

Job summary

Trillium Health Resources is seeking a Claims Specialist III to join the Claims team. This role manages and coordinates claim issues reported by providers, members, or other entities via phone, email, and ticket system, researching and relaying resolutions to the provider community.

The incumbent tracks responses and escalations from the State Department to ensure timely and accurate outcomes. Key duties include coordinating calls and tickets, maintaining up-to-date ticket queues and call logs

Qualifications

• Six (6) years of experience managing deadlines, preparing and reviewing written correspondence, and maintaining records or research in a healthcare or public health setting, including extensive medical claims research.
• Associate's degree and four (4) years of experience managing deadlines, preparing and reviewing written correspondence, and maintaining records or research in a healthcare or public health setting, including extensive medical claims research.
• Bachelor's degree and two (2) years of experience managing deadlines, preparing and reviewing written correspondence, and maintaining records or research in a healthcare or public health setting, including extensive medical claims research.
• Equivalent combination of education and experience.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must 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).

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.

Education

High school diploma or GED

Associate's degree

Bachelor's degree

Job description

Trillium Health Resources is seeking a Claims Specialist III to join the Claims team. This role manages and coordinates claim issues reported by providers, members, or other entities via phone, email, and ticket system, researching and relaying resolutions to the provider community.

The incumbent tracks responses and escalations from the State Department to ensure timely and accurate outcomes. Key duties include coordinating calls and tickets, maintaining up-to-date ticket queues and call logs