Senior Financial Analyst-Claims
About The Position
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. Trillium Health Resources has a career opening for a Senior Financial Analyst to join our Claims Team! The Senior Financial Analyst (Claims) performs analysis, reconciliation, auditing, and reporting functions within the Claims Department. This position is responsible for researching and gathering current claims and financial information to analyze trends, reconcile system data, audit for errors, and generate internal and external reporting. The analyst will look for operating efficiencies and recommend corrective actions as necessary. This role is expected to be performed independently within established procedures and regulations and to receive general instructions on methods of work.
Requirements
- High School diploma/GED and six (6) years of experience in business, accounting, or financial analysis; OR
- Associate’s degree and four (4) years of experience in business, accounting, or financial analysis; OR
- Bachelor’s degree and two (2) years of experience in business, accounting, or financial analysis; OR
- Equivalent combination of education/experience.
- Must have a valid driver’s license
- Must reside within North Carolina
- Must be able to travel within catchment as required.
Nice To Haves
- Experience in the areas of accounting, data analysis, data management, statistics, reporting, and use of databases.
Responsibilities
- 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; identify and report 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.
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) https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook [https://www.myncretirement.gov/systems-funds/local-governmental-employees-retirement-system-lgers/lgers-handbook]
- 401k with 5% employer match and immediate vesting
- Public Service Loan Forgiveness (PSLF) qualifying employer
- Quarterly stipend for remote work supplies
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
251-500 employees
