[Hiring] Appeals Specialist II @Trillium Health Resources

Role Description

Trillium Health Resources has a career opening for an Appeals Specialist II to join our team! The Appeals Specialist II manages appeals or grievance cases from intake through resolution. The role investigates concerns, evaluates findings, and prepares determination communications to ensure accurate, timely resolution and compliance with regulatory and accreditation requirements.

On a typical day, you might:

• Manage assigned appeals, grievances, and/or complaint cases from intake through resolution.
• Investigate cases by gathering documentation, interviewing stakeholders, and analyzing findings.
• Evaluate case information to determine appropriate resolution and required actions.
• Prepare and issue acknowledgment and resolution letters within required time frames.
• Maintain complete case files in accordance with regulatory and accreditation standards.

Qualifications

• High school diploma or GED and six (6) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR
• Associate's degree and four (4) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR
• Bachelor's degree and two (2) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OR
• Equivalent combination of education and experience.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.
• Must be legally authorized to work in the United States without requiring sponsorship for employment now or in the future (ex: OPT F-1, J-1).

Requirements

• Experience working with provider claims, provider network, or provider sanctions (preferred).

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.