Appeals Specialist II at Trillium Health Resources

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina.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.Employee 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 positionsHealth Insurance with no premium for employee coverageFlexible Spending Accounts24 days of Paid Time Off (PTO) plus 12 paid holidays in your first yearNC Local Government Retirement Pension (defined-benefit plan)401k with 5% employer match and immediate vestingPublic Service Loan Forgiveness (PSLF) qualifying employerQuarterly stipend for remote work suppliesQualificationsRequired:High school diploma or GED and six (6) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; ORAssociate's degree and four (4) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; ORBachelor's degree and two (2) years of experience in the Mental Health, Developmental Disabilities, and Substance Use services field; OREquivalent 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.Preferred:Experience working with provider claims, provider network, or provider sanctions.Deadline for Application:Tuesday, September 1, 2026 at 11:59pmTo be considered, submit your application and resume through our ADP Career Center. Your resume must include:Employer name, dates of service (month/year), average hours worked per week, and essential job dutiesEducation details (degree type, date awarded, institution, field of study)Licensure/certification information, if applicableAfter submission, your resume will be reviewed to ensure it meets the essential criteria for the position. You’ll be notified by HR regarding your application status as appropriate. All applicants will receive a final update once the recruitment cycle closes.Trillium Health Resources is an Equal Employment Opportunity (EEO) employer and a drug-free workplace. All candidates must pass a drug test as a condition of employment.

Appeals Specialist II

Emma

Responsibilities

Skills wanted:

Language(s) required:

Melissa Owens

Ashley Msw

Christie Edwards

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