Claims Specialist III

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

📋 Description

• Oversee and coordinate claim-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 collect necessary details concerning claim issues.

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

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

• Manage and coordinate calls and tickets effectively.

• Promptly update and respond to the claims ticket queue and call logs.

• Conduct claims research utilizing claims processing systems, Claims Support Queue tickets, paper claim logs, the knowledge of claims staff, third-party biller implications, Remittance Advice notifications, and provider technical assistance.

• Assist in preparing communications related to providers.

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

⛳️ Requirements

• High school diploma or GED 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, including substantial medical claims research; OR Associate's degree with four (4) years of such experience; OR Bachelor's degree with two (2) years of such experience; OR an equivalent combination of education and experience.

• Comprehensive experience in medical claims research.

• Valid driver’s license.

• Must reside in North Carolina.

• Willingness to travel within the catchment area as needed.

• Must have legal authorization to work in the United States without the need for sponsorship for employment now or in the future.

• 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 candidates are required to 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.

• 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 a 5% employer match and immediate vesting.

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

• Quarterly stipend for remote work supplies.