Role Description

Trillium Health Resources has a career opening for a Claims Director to join our team! This position provides leadership and management for the Claims staff, in the Claims Department, as applicable. The Claims Director is responsible for:

• The processing of all claims and the data elements required to process claims.
• The reporting and analysis of claims data.
• Identification of Medicaid and State Funded services including retroactive Medicaid coverage for paid claims.
• Interaction with the provider community to address specific billing issues.
• Training staff on claims processing and reporting and analysts’ duties.
• Working closely with other leadership members.

This position requires knowledge of the operating claims system, accounting system, data reporting, and overall claims processing and financial analysis operations.

On a typical day, you might:

• Provide leadership, direction, and management of the department.
• Gather, research, and analyze various data to aid Executive Management in decisions regarding provider services.
• Ensure the identification of Medicaid and state funded covered services including retroactive Medicaid coverage to ensure appropriate enrollment and claims payment.
• Interact between providers and department staff to address any enrollment, payment, and billing issues.
• Maintain an understanding of the entire claims management/AR system.
• Maintain an understanding of Medicaid and State funded billing rules.

Qualifications

• Bachelor’s degree in a business field.
• Minimum of three (3) years’ experience with extensive claims filing, data reporting, and financial analysis.
• Knowledge of Professional (Form CMS1500) Institutional (UB04) billing form, ICD-10/CPT/HCPCS coding/CAQH, HIPAA and claims processing.
• Must have a valid driver’s license.
• Must reside within North Carolina.
• Must be able to travel within catchment as required.

• Master’s degree in related business field (Preferred).
• Supervision of two (2) or more employees (Preferred).

Requirements

• Deadline for Application: March 25, 2026 at 11:59pm.
• To 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 duties.
  • Education details (degree type, date awarded, institution, field of study).
  • Licensure/certification information, if applicable.
• After 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.

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.

Company Description

Trillium Health Resources is a Tailored Plan and Managed Care Organization (MCO) serving 46 counties across North Carolina. We manage services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/development (IDD) disabilities. Our mission is to help individuals and families build strong foundations for healthy, fulfilling lives.