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Appeals Support Specialist

Key Facts

Full time
Mid-level (2-5 years)
English

Other Skills

  • •
    Ability To Meet Deadlines
  • •
    Quality Assurance
  • •
    Administrative Functions
  • •
    Microsoft Office
  • •
    Clerical Works
  • •
    Client Confidentiality
  • •
    Communication
  • •
    Time Management
  • •
    Teamwork
  • •
    Customer Service
  • •
    Detail Oriented
  • •
    Problem Solving

Job description

Pay Plan Title: Support Specialist

Working Title: Appeals Support Specialist

FLSA Status: Non-Exempt

Posting Salary Range: $39,900 - $50,673

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/development (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 an Appeals Support Specialist to join our team! The Appeals Support Specialist is responsible for providing confidential administrative and specialist support to General Counsel/Appeals Department, which includes review and mailings of all Adverse Benefit Determination Letters and Appeal Letters, mail tracking, assisting with meeting minutes, data review, and appeal file maintenance. Other duties may include tracking of all court documents.


On a typical day, you might:


  • Finalize the adverse benefit determination notification letters for clinical and administrative denials, which may include peer-to-peer decision letters, as necessary. This process includes reviewing the letter for quality assurance, completing the certified mail process, uploading letters to member records in TBS, and issuing a copy of the letter to the appropriate provider.


  • Ensure notification letters are sent to the member/guardian and provider accurately and timely based on the most current formats and timelines as established by State and Federal regulations, Tailored Plan and contractual requirements, and accreditation standards.
  • Assist providers, members, and other Trillium departments with technical assistance and answers general questions received via phone call or email related to adverse benefit determination and appeals letters.
  • Enter data in a timely manner into TBS, as needed, and utilize the Denials Module to review adverse benefit determination letters and ensure timeliness of all appeal letters and documents. 
  • Provide administrative assistance with projects or assignments to the Appeals and Internal Compliance Departments, including maintaining various departmental files and accurate and timely tracking of departmental projects.


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


Qualifications


Required:

  • High School Diploma or GED. 
  • Minimum of one (1) year clerical experience; OR 
  • Equivalent combination of higher education/experience.
  • Must have a valid driver’s license.
  • Must reside within North Carolina.
  • Must be able to travel within catchment as required.


Preferred:

  • Experience with Microsoft Office suite 
  • Four (4) years of clerical and office management experience


Deadline for Application: Friday, May 1, 2026 at 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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