Trillium Health Resources

Claims Specialist

🌐
Worldwide
❌ Jobs You've Hidden
⭐️ Saved Jobs
✅ Applied Jobs
✉️ Email Alerts
👤 Account
This job opening is no longer available.
Similar Jobs
Claims Analyst I

🕒 May 29

Trend Health Partners

201 - 500

🏥 Healthcare

⚕️ Healthcare Insurance

💳 Fintech

Website
LinkedIn
All Job Openings

Claims Analyst identifying and recovering claim overpayments for commercial health insurance companies and state healthcare programs while collaborating in a dynamic organization.

🇺🇸 United States – Remote

💵 $50k - $60k / year

💰 Private Equity Round on 2023-01

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Claims Specialist III – Mortgage

🕒 May 29

LoanCare

1001 - 5000

💼 Consulting

🛡️ Insurance

📦 Logistics

Website
LinkedIn
All Job Openings

Claims Specialist III responsible for processing mortgage insurance claims for LoanCare. Ensure accuracy, compliance with guidelines, and maintain records in a fast-paced environment.

🇺🇸 United States – Remote

💵 $19 - $28 / hour

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

Senior Claims Adjuster – Crop

🕒 May 28

QBE Insurance

10,000+ employees

🛡️ Insurance

🏦 Banking

💸 Finance

Website
LinkedIn
All Job Openings

Senior Claims Adjuster providing efficient and precise claims services for crop insurance. Collaborating with policyholders and agents through field inspections and investigations.

🇺🇸 United States – Remote

💵 $64k - $95k / year

⏰ Full Time

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

Field Claims Specialist, Workers' Compensation

🕒 May 28

Cisco

10,000+ employees

🔒 Cybersecurity

📡 Telecommunications

🏢 Enterprise

Website
LinkedIn
All Job Openings

Field Claims Specialist investigating and adjusting workers' compensation claims for Strategic Comp. Utilizing experience in California comp laws, communicating with various stakeholders and negotiating settlements.

🇺🇸 United States – Remote

💵 $115k - $125k / year

💰 $2.5M Series A on 1987-01

⏰ Full Time

🟠 Senior

🔴 Lead

📋 Claims Specialist

🦅 H1B Visa Sponsor

Senior Individual Disability Claims Specialist

🕒 May 27

Guardian Life

5001 - 10000

🏥 Healthcare

💼 Consulting

🍽️ Food & Beverage

Website
LinkedIn
All Job Openings

Senior Individual Disability Claims Specialist at Guardian resolving complex claims with outstanding service. Collaborating with internal and external partners, analyzing documents, and making claims decisions.

🇺🇸 United States – Remote

💵 $80.6k - $132.4k / year

💰 Non Equity Assistance on 2016-08

⏰ Full Time

🟠 Senior

📋 Claims Specialist

🦅 H1B Visa Sponsor

Search More Claims Specialist Jobs
🌐
Worldwide
Built by Lior Neu-ner. I'd love to hear your feedback — Get in touch via DM or support@remoterocketship.com
Search
Search Jobs by country
Search jobs by city
Search jobs by job title
Search entry-level jobs
Search junior-level jobs
Search senior-level jobs
Search jobs by tech stack
Search jobs by contract type
Search remote internships
Search remote part-time jobs
Remote jobs Anywhere in the World
Companies Hiring Anywhere in the World
Companies Hiring Sales People Anywhere in the World
Companies Hiring Software Engineers Anywhere in the World
Resources
Advice
Tips for finding remote jobs
Interview questions and answers
Resume examples
Cover letter examples
Post a job
Affiliates
Is Remote Rocketship legit?
Privacy policy
Terms of service
Job board SEO course
OpenClaw job finder
Find jobs using your resume
Jobs by Country
Remote jobs anywhere in the world (Worldwide remote jobs)
Remote jobs United States
Remote jobs Australia
Remote jobs Brazil
Remote jobs Canada
Remote jobs France
Remote jobs Ireland
Remote jobs Germany
Remote jobs Netherlands
Remote jobs Spain
Remote jobs UK
Popular Jobs
Remote data analyst jobs
Remote customer support jobs
Remote executive assistant jobs
Remote marketing jobs
Remote product designer jobs
Remote product manager jobs
Remote project manager jobs
Remote recruiter jobs
Remote sales jobs
Remote software engineer jobs
Jobs by Type
Remote full-time jobs
Remote part-time jobs
Remote contract jobs
Remote internship jobs
Remote entry-level jobs
Remote jobs with no experience required
Remote junior jobs (1-3 years of experience)
Digital nomad jobs
Remote jobs with no degree required
Freelance remote jobs
Temporary remote jobs
Remote jobs hiring now
Stay at home mom jobs

Senior Claims Specialist

Customer Support

• The STAR Specialist provides support to recipients enrolled in the Trillium Support Transition and Reentry (STAR) program.
• STAR provides care coordination pre-release and post-release until the individual moves to ongoing Care Management services and supports.
• The STAR Specialist educates members and guardians throughout the transition process about how to effectively navigate the criminal justice system, behavioral, physical and social services systems and about the existence of community-based services and supports.
• This individual will work with community resources and services to meet the identified needs for recipients who are transitioning back to the community and address specific barriers to reentry which may include access to insurance, disability benefits, transportation, food, clothing, and a safe place to live.
• Ensure that recipients are well connected and provide a warm hand off to identify needed treatment and support.
• Meet with Justice Involved members in-person in Correctional Facilities and in-person in the community to facilitate care management activities.
• Engage members who meet criteria for Transitions to Community Living (TCL) special needs population to provide education about permanent supportive housing, supports, services, and other community resources.
• Assist with transition planning and ensure delivery in the most effective manner with a focus on optimal quality outcomes.
• Utilize person centered planning methods/strategies to gather information, to get to know the members and legally responsible persons to adequately address specific needs of the individual.

Support Transition and Reentry Specialist

Supervisor

• Provide direct supervision and oversight for a localized, multi-disciplinary team supporting Innovations members living with mental health, substance use, and intellectual/developmental disabilities.
• Ensure staff utilize workflows as required to complete Care Management comprehensive assessment and care plans for members as care needs change.
• Establish a team based, person-centered approach to coordination of care to be implemented by all team members that effectively manages a member’s physical health, behavioral health, and social determinant of health needs using established workflows and processes effectively and efficiently.
• Monitor teams to help ensure integration of care through the establishment of a multi-disciplinary team to meet the member’s needs.
• Be familiar with evidenced-based and best practices for members and translate that knowledge into specific process, procedures, and workflows for staff to identify and facilitate effective and efficient coordination and management of care for members.

District Supervisor

General

• Evaluate/investigate the circumstances of the grievance/complaint, which includes interacting with callers to gather information regarding their concern
• Collaborate with other internal Trillium departments to help gather information and documents for the investigation
• Document in the grievance/complaint module
• Interfaces with providers and external entities, as required, to resolve grievances and complaints
• Use professional discretion to determine appropriate response to the contents of complaints or grievances
• Maintain and adjudicate member and recipient grievances and complaints in a timely manner
• Ensure notification letters are updated and sent to the grievant/complainant accurately and timely based on current formats and timelines as established by regulations
• Maintain and update the grievance module, spreadsheets and Trillium’s on-line grievance/complaint submission portal
• Establish and ensure grievances and complaint files are maintained in accordance with contractual and accreditation standards.

Grievance Coordinator

• Provide guidance and support to the PDM Unit.
• Process daily provider data.
• Monitor the Provider Enrollment File (PEF).
• Conduct crosswalk analyses between the Provider Electronic Data (PED), PEF, NC Tracks, and other state systems.
• Reconcile data inaccuracies.
• Map provider data and identify trends and patterns.
• Audit data and adhere to reporting requirements.
• Conduct provider outreach and technical assistance.
• Prepare, process, and review oral and written material.
• Review provider data information received on the Provider Enrollment File (PEF) for accuracy and completeness and make corrections as required.

Provider Data Management Support Specialist

Care Coordinator

• Work collaboratively with licensed Clinicians, Registered Nurses, and Peer Support Specialists to ensure successful discharge/transition planning/post transition monitoring.
• Provide care coordination/care management to assigned TCL individuals who may have identified needs with behavioral health, physical health, co-occurring, co-morbid, or multi-morbid conditions.
• Assess member’s needs who have transitioned into supportive housing to determine if additional support and services are needed for continued independent living.
• Complete assessments as needed.
• Ensure timely and accurate documentation of all planning and coordination efforts in multiple software platforms and State database systems.

Transition Care Coordinator – Southern Region

Transition Care Coordinator – North Central

• Provide direct supervision and oversight for assigned team.
• Ensure the appropriate completion of Housing Assistance Payment (HAP) contracts to include monthly review of invoices.
• Monitor and reconcile housing data in the North Carolina Housing and Finance Agency (NCHFA) platform on an ongoing basis and ensures outstanding tenancy issues are addressed timely.
• Oversee the housing inspection referral process with 3rd party inspection vendor and leads meetings to provide updates on outstanding inspection referrals.
• Provide technical assistance to Housing Specialists and landlords regarding specific member needs.

Housing Supervisor

Manager

• Provide direct supervision and administrative oversight for a localized, Integrated Care Team supporting Innovations members and members without Innovation waiver funding living with mental health, substance use, and intellectual/developmental disabilities.
• Ensure staff utilize workflows as required to complete Care Management Comprehensive Assessment and care plans for members as care needs change.
• Monitor teams to help ensure integration of care through the establishment of an integrated care team (e.g. member, caretaker/legal guardian, family member, PCP, behavioral health provider, specialists, nutritionists, pharmacy, etc.) to meet the member’s needs.
• Track the implementation of workflows, policies, and procedures that screen for and track on members’ social determinants of health needs that can include food, housing, transportation, and interpersonal safety/toxic stress.
• Confirm that team members are able to identify needs, locate community resources, and link members to resources that help to address their social determinants of health needs.
• Establish objective, quantitative performance measures to ensure that the team’s activities are efficient and help to drive member outcomes in addition the quality measures and outcomes set for the organization.

Regional Manager – Innovations Waiver

• Provide oversight and/or outreach, engagement, and support of members receiving Tailored Care Management.
• Facilitate comprehensive assessments of members’ needs and evaluate results to determine the appropriateness and effectiveness of care.
• Ensure the initiation and continuance of integrated care plans that incorporate a member’s physical health, mental health, social support, lifestyle, community involvement, and risks to well-being, among others.
• Facilitate regular meetings with members, both face-to-face and telephonically.
• Consult with providers to gather and share information relevant to each member’s care including care management comprehensive assessments, and reassessments.

Regional Care Manager – Mid-State

Platform Engineer

• Develop, implement, and maintain governance frameworks across the Power Platform ecosystem.
• Administer and support Power Platform environments, including Power Apps.
• Design and deliver hands-on application solutions, including automation workflows and data architecture.
• Maintain a comprehensive understanding of broader platform capabilities.
• Design, build, and deploy scalable solutions using Power Pages, Power Apps, Power Automate, and Dataverse.

Power Platform Developer

Product Analyst

• Monitor and ensure business systems remain operational.
• Act as liaison between multiple departments for business system operations, upgrades, and maintenance.
• Oversee and coordinate User Acceptance Testing (UAT) for any upgrades to the business systems pursuant to the Agile flow.
• Respond to tickets from the KACE System and record the issues and solutions in the KACE System.
• Contribute to the development, implementation, and maintenance of business systems functional architecture, detail systems design, configuration, or program specifications to deliver IT system outcomes that meet user and organizational needs.

Agile Product Analyst

Database Administrator

• Provide assistance with reporting as needed, utilizing department-specific software/systems.
• Develop and modify existing databases, warehouses, and database management systems.
• Plan, coordinate, and implement security measures (including regular audits) to safeguard information in databases and computer files against accidental or unauthorized damage, modification, or disclosure.
• Monitor database and system performance and modify processes to optimize performance.
• Review and approve database modifications and data models, including data elements, data descriptions, and how they are used, following procedures and using pen, template, or computer software.

• Review and pre-screen MHSU service authorization requests.
• Manage and monitor the timeliness of clinical reviews.
• Coordinate and oversee the submission of clinical documentation.
• Track Peer Reviewer decisions and independently communicate outcomes to clinicians.
• Ensure all required notices and actions are issued appropriately and on time.

Utilization Management Coordinator – MH/SU

• Review and pre-screen IDD/MHSU service authorization requests.
• Manage and monitor the timeliness of clinical reviews.
• Coordinate and oversee the submission of clinical documentation.
• Track Peer Reviewer decisions and independently communicate outcomes to clinicians.
• Ensure all required notices and actions are issued appropriately and on time.