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Senior Claims Specialist

Trillium Health Resources

Role overview

Qualifications

  • High School Diploma/GED and two years of experience in claims processing or billing or medical coding field
  • Must have a valid driver's license
  • Must reside within North Carolina
  • Associate’s degree in Healthcare Administration, Business, or a Human Services field preferred

Responsibilities

  • Analyze and audit claims adjudication results for accuracy according to NC Medicaid guidelines
  • Provide training and technical assistance to provider agencies based on audit findings
  • Identify adjudication errors and provider billing errors
  • Communicate with internal and external stakeholders to facilitate claims resolution

Key facts

Hard skills

Billing Auditing Medical Coding Adjudication Health Administration Care Management Software

Other skills

  • Training And Development
  • Communication
  • Problem Solving

About the company

Trillium Health Resources logo

Trillium Health Resources

Health Insurance (Payers)

Trillium Health Resources manages specialty behavioral health care for eastern North Carolinians across 28 counties. Trillium is committed to transforming lives and building community well-being through partnership, access to services and proven solutions designed to help those we serve reach their fullest potential. Everyone on Trillium’s staff--our care managers, call center, claims agents, project managers, and IT staff--all contribute to this mission. We offer a challenging, engaging work environment where staff take home more than a paycheck. Our performance management plan includes regular check-ins to examine individual employee goals and professional development plan. Our departments work on cross-functional, short-term projects and long ranging initiatives. Every day we see the results of our dedication, in the smiles of children on our accessible playgrounds and pride on the face of an adult cooking a meal for the first time. By joining Trillium, you are doing more than going to work…you are transforming lives. We help those with mental health conditions, intellectual and developmental disabilities, traumatic brain injury, and substance use disorders (Medicaid members and state-funded recipients) get the services they need to improve well-being and live fulfilling lives. We are dedicated to carrying out our mission by investing in the health and well-being of the communities we serve and empowering individuals with access to services, tools and resources to live a fulfilling life. Trillium reserves the right to hide material (comments, images and/or links to other sites) that contains anything vulgar or sexually explicit; is spam; advocates or depicts illegal activity; targets or disparages any ethnic, racial, other type of group; contains personal attacks of any kind; promotes private business ventures, services, or products; campaigns for public office or promotes a political organization; infringes on copyrights or trademarks; or is off topic.

Company details

Company typeSME
IndustryHealth Insurance (Payers)
Company size501 - 1000

Links

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Job description

Pay Plan Title: Data Analyst

Working Title: Senior Claims Specialist 

FLSA Status: Exempt

Posting Salary Range: $41,102 - $59,518

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 a Senior Claims Specialist to join our team! The Senior Claims Specialist performs data analysis, auditing and finalizes adjudication results for claims designated for pre-payment review and post payment review of claim adjudication results through research and knowledge of billing guidelines and policies established by CMS, and NC Medicaid as well as Trillium policies and procedures. This position is also responsible for assisting providers by phone or email with claims processing questions as well as communicating with internal and external stakeholders to facilitate efficient claims resolution.


On a typical day, you might:


  • Analyze and audit claims adjudication results to determine if claims were accurately submitted and processed according to NC Medicaid guidelines. 
  • Analyze and audit claim attachments/medical documentation necessary to appropriately adjudicate a claim.
  • Analyze, audit and take appropriate actions for claims delayed for adjudication due to rejection errors.
  • Identify adjudication errors, provider billing errors, and the need for technical assistance. 
  • Ensure the claims system and manual processes are incorporating required actions by reviewing and applying information from departmental trainings, published coverage policies and other NCDHHS documents.
  • Provide training, education and technical assistance to provider agencies based on analysis or audit findings related to basic claim submission guidelines, denial management, system use and updates.
  • Recognize and report suspected system issues or concerns to immediate supervisor for follow-up based on data analysis.


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/GED and two (2) years of experience in the claims processing or billing or medical coding field; 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:

  • Associate’s degree in Healthcare Administration, Business, or a Human Services field (such as Psychology, Social Work, etc.)
  •  Hospital claims experience and knowledge
  •  Experience in the areas of physical health claims processing or medical coding 
  •  Experience working with Managed Care billing software
  • Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS) or similar certification preferred. 


Deadline for Application: July 16, 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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