Claims Specialist III

This is a fully remote position, open to applicants in North Carolina.

📋 Description

• Oversee and coordinate claim-related inquiries received from providers, members, or other organizations through phone, email, and ticketing systems.

• Offer assistance and information to the provider community.

• Investigate and compile necessary details concerning claim issues.

• Communicate resolutions and/or summaries of issues back to the provider community.

• Monitor, review, and ensure timely and accurate responses to inquiries, claims issues, and escalations submitted by the State Department.

• Organize and manage calls and tickets.

• Update and respond to the claims ticket queue and call logs.

• Perform claims research using the claims processing system, Claims Support Queue, paper claim logs, claims staff history, impacts from third-party billers, Remittance Advice notifications, and provider technical assistance.

• Aid in drafting communications related to providers.

• Analyze trends in provider issues and suggest updates for the Claims Processing System and Claims Staff training.

⛳️ Requirements

• High school diploma or GED, along with six (6) years of experience in managing deadlines, preparing and reviewing written correspondence, and maintaining records or conducting research in a healthcare or public health environment, which includes significant medical claims research; OR an Associate's degree with four (4) years of such experience; OR a Bachelor's degree with two (2) years of such experience; OR an equivalent combination of education and experience.

• Significant experience in medical claims research.

• A valid driver’s license.

• Must be a resident of North Carolina.

• Ability to travel within the designated area as required.

• Preferred educational background in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities.

• Experience in the public mental health sector is highly preferred.

• Must successfully pass a drug test as a condition of employment.

🏝️ Benefits

• Competitive benefits package.

• Work-from-home options available for most positions.

• Flexible work schedules with management approval for certain roles.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts available.

• 24 days of Paid Time Off (PTO).

• 12 paid holidays in the first year.

• NC Local Government Retirement Pension (defined-benefit plan).

• 401k plan with a 5% employer match and immediate vesting.

• Qualifying employer for Public Service Loan Forgiveness (PSLF).

• Quarterly stipend for remote work supplies.