Claims Analyst Supervisor

Pay Plan Title : Supervisor I

Working Title : Claims Analyst Supervisor

Cost Center : 43 / Claims

FLSA Status : Exempt

Posting Salary Range : $61,002 - $68,959

Office Location : Remote within North Carolina.

POSTING DETAILS : Make an Impact

Trillium Health Resources is a local governmental agency (LME / MCO) in North Carolina that manages serious mental health, substance use, and intellectual / developmental disability services. Serving in 46 counties, we help individuals and their families strengthen well-being and build foundations for a healthy life.

Join our team as we empower others to live their best lives by providing access to quality healthcare. We offer a challenging, engaging work environment where staff take home more than a paycheck. Every day, we see the results of our dedication - in the smiles of children on our accessible playgrounds and in the pride on the face of an adult cooking a meal for the first time. Working at Trillium Health Resources is more than just a job; it is an opportunity to make a direct impact on the communities we serve.

At Trillium, we know that empowering others begins with supporting and developing our team. That's why we offer competitive benefits and work-from-home flexibility so that our employees thrive outside of the office. We're also committed to building a diverse, inclusive culture where all employees have the potential to grow professionally and personally.

What We're Looking For

Trillium has a career opening for a Claims Analyst Supervisor. This position will lead, maintain and enhance claims analyses / auditing functions within the Claims Department. The Claims Analyst Supervisor performs analysis, reconciliation, auditing and reporting functions. Researching and gathering current claim and financial information to analyze trends, reconcile system data, audit for errors, and generate internal and external reporting are ongoing activities of this role.

On a typical day, you might :

• Examine trends, claim statistics, and provider payments, in order to monitor achievement of department goals, improve processes and determine claims processing accuracy / timeliness.
• Reconcile data flow between processing systems; identifies and reports any discrepancies.
• Generate internal and external reporting of claims statistics, including data by fund source, disability, and service category.
• Maintain monthly / weekly / quarterly claims statistics and auditing spreadsheets (i.e. claim denials, claims processed, etc.). Effectively analyze data and trends and utilize quality management tools to improve organizational performance. Develop and present management reports.
• Continually assess and redesign, where appropriate, claims analysis, reconciliation, auditing and reporting processes.
• Review claims data for audits and reviews to determine claims processing accuracy and reporting validity / integrity.
• Validate, improve, and / or create Claims Data reporting.
• Assists with report development for various projects. May assist with various internal / external trainings.
• Serve as process backup to the Data Analysis Manager.
• Communicate with staff, supervisors and managers during research and regarding deviations found.

Employee Benefits :

Trillium knows that work / life balance is important. That's why we offer our employees competitive benefits and flexibility that is second to none. Take a look at what we have to offer :

Qualifications :

Required Education / Experience :

Bachelor's degree with a minimum of five (5) years' experience in business, accounting, or financial analysis.

Master's degree and a minimum of three (3) years' experience in business, accounting, or financial analysis.

Required License / Certification :

Must have a valid driver's license

Location :

Remote within North Carolina.

Must reside in North Carolina to be considered for remote status.

Deadline for application : January 31, 2025

To be considered for employment, all candidates are required to submit an application through ADP and upload a current resume. Your resume must provide your level of education and detailed work experience, including :

Dates of service (month & year)

Degree type

After submitting your application through our career center in ADP, your resume will be reviewed to ensure that your skills and experience meet the essential criteria for the role you have applied for.

You will be notified by HR on the status of your application as appropriate. All applicants will receive a final email when the recruitment cycle for the position has closed.

Join our Talent Community through our ADP career center to stay informed about positions you may qualify for. Remember to keep an update resume in the Talent Community profile.

The diversity of the communities we serve is reflected in our employees. Trillium Health Resources is an Equal Employment Opportunity (EEO) employer.

Trillium Health Resources is a drug-free workplace. Candidates are required to pass a drug test as a condition of employment.

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Salary : $61,002 - $68,959