Claims Specialist III

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

📋 Description

• Oversee and coordinate claims-related issues received from providers, members, or other entities through telephone, email, and ticketing systems.

• Offer support and information to the provider community.

• Investigate and compile information concerning claim-related issues.

• Communicate resolutions and/or summaries of claim issues back to providers.

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

• Manage and coordinate calls and tickets effectively.

• Timely update and respond to claims ticket queues and call logs.

• Perform claims research utilizing claims processing systems, Claims Support Queue tickets, paper claim logs, input from claims staff, third-party biller impacts, Remittance Advice notifications, and provider technical assistance.

• Assist in drafting communications related to providers.

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

⛳️ 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 setting, which includes significant medical claims research; OR an Associate's degree with four (4) years of experience in the same domains; OR a Bachelor's degree with two (2) years of experience in the same areas; OR a suitable combination of education and experience.

• In-depth experience in medical claims research.

• A valid driver's license is required.

• Candidates must reside within North Carolina.

• Ability to travel within the designated catchment area as needed.

• A degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities is preferred.

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

• All applicants must successfully pass a drug test as a condition of employment.

🏝️ Benefits

• A collaborative, mission-driven work environment.

• Competitive benefits package.

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

• Opportunities for professional development in a diverse and inclusive culture.

• Flexible work schedules, with some roles requiring management approval.

• Health Insurance with no premium for employee coverage.

• Flexible Spending Accounts.

• 24 days of Paid Time Off (PTO).

• 12 paid holidays within your 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.