[Hiring] Appeals Manager @TRILLIUM HEALTH RESOURCES

Role Description

Trillium Health Resources has a career opening for an Appeals Manager to join our team! The Appeals Manager is responsible for managing and coordinating Trillium’s provider appeals processes. The management and coordination of these processes entails:

• Overseeing the Provider Appeals Team and supervising provider appeals staff.
• Coordinating with vendors and internal departments to ensure compliance.
• Reviewing and ensuring preparation for all panel appeal meetings and court hearings for appeals, which includes prepping files and performing research on controlling authority (coverage policies and service definitions, State and federal statutes and regulations, applicable contracts, agency policies and procedures, etc.).
• Oversight of appeal files.
• Supporting staff in drafting/reviewing provider resolution letters in accordance with practices established by the Legal Department.

On a typical day, you might:

• Oversee and manage Trillium’s provider appeals processes.
• Supervise provider appeals staff and evaluate the effectiveness/efficiency of the department through regularly scheduled individual staff supervision and staff meetings.
• Interface with vendors and internal business units to ensure compliance and good communication across the department.
• Research, read and interpret controlling authority (coverage policies and service definitions, State and federal statutes and regulations, applicable contracts, agency policies & procedures, etc.).
• Oversee accurate and complete files for each appeal with all documents used in decision making.
• Prepare files for audits and reviews, including, but not limited to, external quality reviews and accreditation reviews.
• Support staff in drafting appeal resolution letters in accordance with practices established by the Legal Department and ensure all appeals are processed and completed timely within accordance with legal and contractual and accreditation standards.
• Prepare reports for internal and external stakeholders.

Qualifications

• Required: Associate’s degree and three (3) years’ experience in appeals, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department; OR Bachelor’s degree and minimum one (1) year experience in appeals, performing research under the guidance of an attorney or Legal Department, conducting compliance and risk management activities, and drafting correspondence in accordance with practices established by an attorney or Legal Department; 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.
• Preferred: Human services; liberal arts or humanities. Advanced degree preferred.
• Supervision of two (2) or more employees.
• Experience in the public mental health field, the criminal justice system, or a legal environment is highly desired due to the complexity of the work of the agency.

Requirements

• Deadline for Application: Thursday, June 25, 2026 at 11:59pm.

Benefits

• Typical working hours: 8:30 am – 5:00 pm; flexible work schedules available for some positions 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.