Claims Manager at TRILLIUM HEALTH RESOURCES

, North Carolina, United States -

Full Time

Start Date

Immediate

Expiry Date

06 Mar, 26

Salary

90457.0

Posted On

06 Dec, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Claims Processing, Data Reporting, Problem Solving, Training, Mentoring, Analysis, Research, Billing Issues, Team Collaboration, Procedure Development, Provider Interaction, Claims Appeals, Supervisory Skills, Communication, Attention To Detail, Time Management

Industry

Insurance

Description

Pay Plan Title: Unit Manager Working Title: Claims Manager Cost Center: 4300/Claims Position Number: 80744 FLSA Status: Exempt Posting Salary Range: $67,632 - $90,457 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/developmental (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: * A collaborative, mission-driven work environment * 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. If you are looking for a unique opportunity to make a tangible impact on the lives of others, apply today! What We’re Looking For Trillium Health Resources has a career opening for a Claims Manager to join our team! The Claims Manager is responsible for ensuring accurate processing of all claims, the appropriate data elements required to process claims accurately, and reporting and analysis of claims data, including responding to claim appeals. This position will work closely with the Claims Processing Supervisors and Claims Processing Assistants to resolve provider-related issues related to claims submissions and payments in a timely manner. This position will also work closely with the Fiscal Analyst Manager to resolve claim issues and with Trillium’s Appeals Team on claim appeals. On a typical day, you might: * 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: 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 * NC Local Government Retirement Pension (defined-benefit plan) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook [https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook] * 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 Deadline for Application: December 30,2025@11:59pm 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. Join our Talent Community through ADP to stay informed about future opportunities. Be sure to keep your resume updated in your profile. 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

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Responsibilities

The Claims Manager is responsible for ensuring accurate processing of all claims and reporting and analysis of claims data. This position involves resolving provider-related issues and working closely with various teams to address claim appeals and payment issues.