Key Facts

Remote From:

Indiana (USA) , North Carolina (USA)

Category: M&A Manager

Full time

Mid-level (2-5 years)

English

Hard Skills

Appeals Correspondence Analysis Risk Management Legal Interpretation Court Experience Human Services

Other Skills

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Research
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Supervision
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Communication
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Teamwork
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Problem Solving

Roles & Responsibilities

Associate’s degree and three (3) years’ experience in appeals, or
Bachelor’s degree and minimum one (1) year experience in appeals, or
Equivalent combination of education/experience
Must have a valid driver’s license and reside within North Carolina

Requirements:

Oversee and manage Trillium’s provider appeals processes
Supervise provider appeals staff and evaluate department effectiveness
Interface with vendors and internal business units to ensure compliance
Research and interpret controlling authority related to appeals

Trillium Health Resources

Insurance

About Trillium Health Resources

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 type: SME

Industry: Insurance

Founded: 2018

Company size: 501 - 1000

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Job description

Pay Plan Title: Unit Manager

Working Title: Appeals Manager

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/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 Manager to join our team! The Appeals Manager is responsible for managing and coordinating Trillium’s provider appeals processes. The management and coordination of these processes entails: overseeing the Provider Appeals Team and supervising provider appeals staff; coordinating with vendors and internal departments to ensure compliance, reviewing and ensuring preparation for all panel appeal meetings, court hearings for appeals, which includes prepping files and performing research on controlling authority (coverage policies and service definitions, State and federal statutes and regulations, applicable contracts, agency policies and procedures, etc.), oversight of appeal files, and supporting staff in drafting/reviewing provider resolution letters in accordance with practices established by the Legal Department.

On a typical day, you might:

Oversee and manage Trillium’s provider appeals processes.
Supervise provider appeals staff and evaluate the effectiveness/efficiency of the department through regularly scheduled individual staff supervision and staff meetings.
Interface with vendors and internal business units to ensure compliance and good communication across the department.
Research, read and interpret controlling authority (coverage policies and service definitions, State and federal statutes and regulations, applicable contracts, agency policies & procedures, etc.).
Oversee accurate and complete files for each appeal with all documents used in decision making.
Prepare files for audits and reviews, including, but not limited to, external quality reviews and accreditation reviews.
Support staff in drafting appeal resolution letters in accordance with practices established by the Legal Department and ensure all appeals are processed and completed timely within accordance with legal and contractual and accreditation standards.
Prepare reports for internal and external stakeholders.

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 available for some positions 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:

Associate’s degree and three (3) years’ experience in appeals, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department; OR
Bachelor’s degree and minimum one (1) year experience in appeals, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department; 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:

Human services; liberal arts or humanities. Advanced degree preferred.
Supervision of two (2) or more employees.
Experience in the public mental health field, the criminal justice system, or a legal environment is highly desired due to the complexity of the work of the agency.

Deadline for Application: Thursday, June 25, 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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