Claims Specialist III

Trillium Health Resources

. Manage and coordinate claim issues received from providers, members, or other entities via telephone, email, and ticket system .

Posted 11/4/2026full-timeRemote • North Carolina • United StatesJuniorMid-Level💰 $56,270 - $69,898 per yearWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in managing and coordinating claims issues, providing support to the provider community, and conducting extensive medical claims research. Proficient in maintaining accurate records and preparing written correspondence in a healthcare or public health setting.

Highest-signal resume keywords

Extensive Medical Claims Research ExperienceClaims Processing SystemsProvider Communication DraftingDeadline ManagementPublic Mental Health Field Experience

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ResearchClaims Issue CoordinationRecord MaintenanceWritten Correspondence PreparationData Tracking and Review

Soft Skills

CommunicationProblem-SolvingOrganizational Skills

Tools & Technologies

Claims Support QueueClaims Processing SystemsTicketing System

Certifications & Qualifications

Valid Driver’s License

Industry Keywords

HealthcarePublic HealthProvider CommunityMental Health

About the role

Key responsibilities & impact

Manage and coordinate claim issues received from providers, members, or other entities via telephone, email, and ticket system
Provide support and information to the provider community
Research and gather necessary information regarding claim issues
Relay resolutions and/or issue summaries to the provider community
Track, review, and coordinate timely and accurate responses to inquiries, claims issues, and escalations submitted by the State Department
Coordinate and manage calls and tickets
Update and respond to the claims ticket queue and call logs in a timely manner
Conduct claims research using claims processing systems, Claims Support Queue tickets, paper claim logs, claims staff knowledge, third-party biller impacts, Remittance Advice notifications, and provider technical assistance
Assist with drafting provider-related communications
Review trends in provider issues and recommend updates to the Claims Processing System and Claims Staff training

Requirements

What you’ll need

High school diploma or GED and six (6) years of experience managing deadlines, preparing and reviewing written correspondence, and maintaining records or research in a healthcare or public health setting, including extensive medical claims research; OR Associate's degree and four (4) years of such experience; OR Bachelor's degree and two (2) years of such experience; OR equivalent combination of education and experience
Extensive medical claims research experience
Valid driver’s license
Must reside within North Carolina
Must be able to travel within catchment as required
Must be legally authorized to work in the United States without requiring sponsorship for employment now or in the future
Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities preferred
Experience in the public mental health field highly desired
All candidates 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 your 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