Claims Specialist II
Trillium Health Resources
Posted: 10/21/2026
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Trillium Health ResourcesPosted 10/21/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $42,765 - $61,546 per yearWebsite
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in claims processing, auditing, and analysis, with a strong understanding of CMS, NC Medicaid, and Trillium billing guidelines. Provides training and technical assistance to stakeholders while effectively communicating to resolve claims issues.
Highest-signal resume keywords
Claims ProcessingMedical CodingData AnalysisTraining and EducationManaged Care Billing Software
About the role
Key responsibilities & impact- Perform data analysis and auditing for claims designated for pre-payment review
- Review claims adjudication results through research and knowledge of CMS, NC Medicaid, and Trillium billing guidelines and policies
- Analyze and audit claim attachments and medical documentation
- Take appropriate actions for claims delayed due to rejection errors
- Identify adjudication errors, provider billing errors, and technical assistance needs
- Review and apply departmental trainings, published coverage policies, and NCDHHS documents
- Provide training, education, and technical assistance to provider agencies on claim submission guidelines, denial management, system use, and updates
- Assist providers by phone or email with claims processing questions
- Communicate with internal and external stakeholders to facilitate efficient claims resolution
- Report suspected system issues or concerns to the immediate supervisor
Requirements
What you’ll need- High School Diploma or GED and two (2) years of experience in claims processing, billing, or medical coding; OR equivalent combination of education and experience
- Valid driver’s license
- Must reside within North Carolina
- Must be able to travel within catchment as required
- Legally authorized to work in the United States without requiring sponsorship now or in the future
- Preferred: Associate’s degree in Healthcare Administration, Business, or a Human Services field
- Hospital claims experience and knowledge preferred
- Experience in physical health claims processing or medical coding preferred
- Experience with Managed Care billing software preferred
- Certified Professional Coder (CPC), Certified Professional Biller (CPB), Certified Medical Reimbursement Specialist (CMRS), or similar certification preferred
- Must pass a drug test as a condition of employment
Benefits
Comp & perks- Competitive benefits
- Work-from-home options for most positions
- Flexible work schedules with management approval for some roles
- Health insurance with no premium for employee coverage
- Flexible Spending Accounts
- 24 days of Paid Time Off (PTO) plus 12 paid holidays in the first year
- NC Local Government Retirement Pension (defined-benefit plan)
- 401k with 5% employer match and immediate vesting
- Public Service Loan Forgiveness (PSLF) qualifying employer
- Quarterly stipend for remote work supplies
- Professional growth opportunities
- Collaborative, mission-driven work environment
- Diverse, inclusive culture
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims AuditingClaims AdjudicationBilling GuidelinesMedical Documentation AnalysisError Identification
Soft Skills
CommunicationTechnical AssistanceProblem-Solving
Tools & Technologies
Managed Care Billing Software
Certifications & Qualifications
Certified Professional Coder (CPC)Certified Professional Biller (CPB)Certified Medical Reimbursement Specialist (CMRS)
Industry Keywords
CMSNC MedicaidTrilliumHealthcare AdministrationDenial Management