Job Closed

This listing is no longer active.

TRILLIUM HEALTH RESOURCES logo
TRILLIUM HEALTH RESOURCES

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.

Claims Relations Coordinator

Location

United States + 9 moreAll locations: United States | United Kingdom | Canada | Germany | France | India | Brazil | Australia | Estonia | Japan

Posted

29 days ago

Salary

$54.1K - $67.2K / year

Seniority

Mid Level

No structured requirement data.

Job Description

Claims Relations Coordinator

TRILLIUM HEALTH RESOURCES

Role Description The Claims Relations Coordinator is responsible for managing and coordinating claim issues received by providers, members, or other entities via telephone call, email, and ticket system. The coordination of claim issues includes providing support and information to the provider community. This position will research and gather necessary information regarding claim issues and relay the resolution and/or summary of these issues to the provider community. The Claims Relations Coordinator will also be responsible for tracking, reviewing, and coordinating timely and accurate responses that may include inquiries, claims issues, and escalations submitted by the State Department. On a typical day, you might: - Coordinate and manage calls and tickets. - Ensure claims ticket queue and call logs are updated and responded to timely to allow for timely notifications to the provider community on the resolution and/or summary of their issues. - Conduct claims research, including, but not limited to: - Review of claims processing system - Review of previous and current tickets in the Claims Support Queue - Review of paper claim logs - Working with other claims staff to learn history - Third party biller impacts - Remittance Advice notifications - Provider technical assistance - Assist with drafting provider related communications. - Review trends of provider issues and make recommendations for updates needed in the Claims Processing System and Claims Staff training. Qualifications - High School diploma/GED with a minimum of six (6) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of six (6) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; - OR Associate’s degree with a minimum of four (4) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of four (4) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; - OR Bachelor’s degree with a minimum of two (2) years of experience in coordinating multiple deadlines, drafting and reviewing written correspondence, and maintaining files and/or research in a healthcare or public health setting which includes a minimum of two (2) years of extensive medical claims research including reviewing denials, member eligibility, communicating both written and verbally with the provider community, and analyzing claim reports; - OR Equivalent combination of education/experience. - Must have a valid driver’s license. - Must reside within North Carolina. - Must be able to travel within catchment as required. Requirements - Degree in Business Administration, Healthcare Administration, Human Services, Public Administration, Liberal Arts, or Humanities (preferred). - Experience in the public mental health field is highly desired due to the complexity of the work of organization. Benefits - Typical working hours: 8:30 am – 5:00 pm; flexible work schedules with some roles with management approval. - Work-from-home options available for most positions. - 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.

Related Categories

Related Job Pages

More Claims Specialist Jobs

Gallagher logo

Liability Claims Trainee

Gallagher

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on protected characteristics by applicable federal, state, or local laws.

Full TimeRemoteTeam 5,001-10,000

Role Description At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. Qualifications - Bachelor’s degree or 4-year degree from an accredited institution preferred. - Candidates possessing a Bachelor’s degree will receive preferential treatment. Others with proven experience will be considered. Requirements - Active listening skills - Problem-solving mindset - Adaptable to changes in procedures and technology - Computer literacy, including strong familiarity with M365 products (e.g. Outlook, Word, and basic Excel and PPT) - Strong verbal and written communication skills - Strong time management and ability to multi-task - Detail-oriented - Curious, learning-focused mindset Benefits - Medical/dental/vision plans, which start from day one! - Life and accident insurance - 401(K) and Roth options - Tax-advantaged accounts (HSA, FSA) - Educational expense reimbursement - Paid parental leave - Digital mental health services (Talkspace) - Flexible work hours (availability varies by office and job function) - Training programs - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing - Charitable matching gift program - And more...

United States
$60K / year
Job Closed

• Responsible for reviewing and processing insurance claims by verifying policy coverage • Gathering necessary information, evaluating claim validity, and determining the appropriate payout amount • Interact with policyholders, agents, and other stakeholders to facilitate the claims process efficiently • Ensure compliance with HIPPA regulations, including confidentiality • Ability to work in multiple claim systems and provide support to multiple departments, including litigation and legal departments

United States
$45K - $50K / year
Job Closed
Gallagher logo

Senior General Liability Claims Adjuster

Gallagher

Inclusion and diversity (I&D) is a core part of our business, and it’s embedded into the fabric of our organization. For more than 95 years, Gallagher has led with a commitment to sustainability and to support the communities where we live and work. Gallagher embraces our employees’ diverse identities, experiences and talents, allowing us to better serve our clients and communities. We see inclusion as a conscious commitment and diversity as a vital strength. By embracing diversity in all its forms, we live out The Gallagher Way to its fullest. Gallagher believes that all persons are entitled to equal employment opportunity and prohibits any form of discrimination by its managers, employees, vendors or customers based on protected characteristics by applicable federal, state, or local laws.

Full TimeRemoteTeam 5,001-10,000

Role Description At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose. Qualifications - High School Diploma. - Minimum of 5 years related claims experience. - 2-3 years of litigation experience. - Appropriate licensing and/or certification in all states in which claims are being handled. - Knowledge of accepted industry standards and practices. - Computer experience with related claims and business software. Requirements - Claims Background: General Liability (BI) and Litigation Management. - Jurisdictional Experience: Any. - Active Adjusters' licenses: Any. - Location: This role is eligible for fully remote work. Benefits - Medical/dental/vision plans, which start from day one! - Life and accident insurance. - 401(K) and Roth options. - Tax-advantaged accounts (HSA, FSA). - Educational expense reimbursement. - Paid parental leave. - Digital mental health services (Talkspace). - Flexible work hours (availability varies by office and job function). - Training programs. - Gallagher Thrive program – elevating your health through challenges, workshops and digital fitness programs for your overall wellbeing. - Charitable matching gift program. - And more...

United States
Full TimeRemoteTeam 201-500Since 1933H1B No Sponsor

• Investigate and evaluate liability claims to determine coverage, liability exposure, damages, and appropriate resolution strategy • Analyze claim exposure and recommend the proper course of action to achieve timely and appropriate settlement outcomes • Set, monitor, and adjust claim reserves in accordance with established reserving practices • Communicate effectively with insureds, claimants, attorneys, clients, vendors, and other involved parties throughout the claim lifecycle • Develop and coordinate litigation and defense strategies with assigned defense counsel when applicable • Negotiate settlements and manage claims through resolution in alignment with client expectations and authority levels • Ensure all claims are handled in accordance with client guidelines, Davies (PGCS) policies and procedures, and applicable statutory, regulatory, and ethical requirements • Maintain clear, accurate, and timely documentation of all claim activity to support defensible claim outcomes • Plan, prioritize, and organize workload effectively to meet service level expectations and deadlines • Embrace ongoing learning, feedback, and professional development in a dynamic claims environment

Alabama
$75K - $85K / year
Job Closed