Claims Specialist III

1. About Our Client:

The organization is a Tailored Plan and Managed Care Organization serving 46 counties in North Carolina. It manages services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/developmental disabilities. The organization aims to support individuals and families in building strong foundations for healthy, fulfilling lives.

2. About the Opportunity:

The Claims Specialist III role is responsible for managing and coordinating claim issues received from providers, members, or other entities through calls, emails, and a ticket system. This position supports the provider community by researching claim issues, providing resolutions or summaries, and tracking responses to inquiries and escalations. The role is critical in ensuring timely and accurate communication regarding claims.

3. Responsibilities:

• Manage and coordinate calls and tickets related to claim issues.
• Maintain and update claims ticket queue and call logs for timely provider notifications.
• Conduct research on claims processing systems, previous and current tickets, paper claim logs, and related notifications.
• Assist in drafting communications for providers.
• Analyze trends in provider issues and recommend updates to claims processing and staff training.

4. Requirements:

• High school diploma or GED with six years of relevant healthcare or public health experience including medical claims research; or
• Associate''s degree with four years of relevant experience; or
• Bachelor''s degree with two years of relevant experience; or
• Equivalent combination of education and experience.
• Valid driver’s license.
• Residency within North Carolina.
• Ability to travel locally as required.
• Preferred: Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities.
• Preferred: Experience in public mental health field.

5. Pay Range and Compensation Package:

• Salary range: $56,270 to $69,898 annually.

6. Benefits & Perks:

• Work hours from 8:30 am to 5:00 pm with flexible scheduling options.
• Work-from-home options for most positions.
• Health insurance with no premium for employee coverage.
• Flexible Spending Accounts.
• 24 days of paid time off plus 12 paid holidays in the first year.
• Defined-benefit pension plan through NC Local Government Retirement.
• 401(k) plan with 5% employer match and immediate vesting.
• Public Service Loan Forgiveness qualifying employer.
• Quarterly stipend for remote work supplies.

Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.

Note:

RemoteHunter is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.