Appeals Specialist II

This is a Fully Remote Job
1. About Our Client:
Trillium Health Resources is a Tailored Plan and Managed Care Organization serving 46 counties in North Carolina. The organization manages services for individuals with serious mental health needs, substance use disorders, traumatic brain injuries, and intellectual/developmental disabilities. Its mission focuses on helping individuals and families build strong foundations for healthy, fulfilling lives.
2. About the Opportunity:
The Appeals Specialist II is responsible for managing appeals and grievance cases from intake through resolution. This role investigates concerns, evaluates findings, and prepares determination communications to ensure timely and compliant resolution in accordance with regulatory and accreditation standards. The position contributes to the organization by ensuring accurate case management and supporting overall service quality.
3. Responsibilities:
Manage assigned appeals, grievances, and complaint cases from intake to resolution.
Investigate cases by gathering documentation, interviewing stakeholders, and analyzing findings.
Evaluate case information to determine appropriate resolutions and required actions.
Prepare and issue acknowledgment and resolution letters within required time frames.
Maintain complete case files according to regulatory and accreditation standards.
4. Requirements:
High school diploma or GED with six years of experience in Mental Health, Developmental Disabilities, and Substance Use services; OR
Associate's degree with four years of related experience; OR
Bachelor's degree with two years of related experience; OR
Equivalent combination of education and experience.
Valid driver’s license.
Residence within North Carolina.
Ability to travel within the service area as required.
Preferred: Experience with provider claims, network, or sanctions.
5. Pay Range and Compensation Package:
$56,270 - $69,898 annual salary.
6. Benefits & Perks:
Typical working hours: 8:30 am – 5:00 pm; flexible schedules with some management approval.
Work-from-home options for most positions.
Health insurance with no premium for employee coverage.
Flexible Spending Accounts.
24 days of Paid Time Off plus 12 paid holidays in the first year.
North Carolina Local Government Retirement Pension (defined-benefit plan).
401(k) with 5% employer match and immediate vesting.
Public Service Loan Forgiveness qualifying employer.
Quarterly stipend for remote work supplies.
Equal Opportunity Statement:
Equal Opportunity Statement: Our client is an equal opportunity employer. They celebrate diversity and are committed to creating an inclusive environment for all employees. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, or national origin.
Note:
TalentHop is a recruitment partner of this role. Please note that all employment decisions, including candidate assessment, interviews, hiring, compensation, and employment terms, are made exclusively by the hiring employer.

Work arrangement
Yes