Sr. Claim Recovery Specialist - The Phia Group

The Phia Group provides, amongst other things, claim recovery services for health benefit plans. When a health benefit plan pays medical bills, and we later discover someone else should have paid those medical bills, The Phia Group – on behalf of the health plan – will seek to recover the funds. The Senior Claims Recovery Specialist plays an important role in this effort, by determining whether another proper payer exists, and pursuing fund reimbursement.

Tasks Include: Handling files for the Recovery Department. Communicating with attorneys, adjusters and plan participants (insured participants) to determine potential sources of recovery (i.e. auto insurance, workers compensation, first party coverage, third party coverage, etc.). Communicating with clients (health benefit plan sponsors, employers, and claims administrators) via phone and email. Performing additional tasks (on an as-needed basis) to assist with the day-to-day activities of the Recovery Department.

At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their dependents, you can look forward to not only exceptional benefits for yourself but also being immersed in a company that has been named one of USA Today’s top workplaces for 2024. We believe that this distinction, which stems from the fourth-annual survey co-sponsored by Energage and USA Today, reflects our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees.

The Phia Group is committed to fostering, cultivating, and preserving a culture of diversity and inclusion. With this in mind, we always seek to attract and develop candidates who share our passion for the healthcare industry and our commitment to diversity and inclusion. We encourage applicants who share that passion to explore this opportunity to join our dynamic team.

Essential Duties and Responsibilities:

• Calling adjusters and attorneys for status
• Negotiating with attorneys
• Being familiar with different case laws (with use of passionforsubro.com)
• Drafting, mailing & faxing correspondence
• Calling insurance carriers for claim information (claim #, adjuster name, phone, fax & mailing address)
• Providing clients with accident details, reduction requests, etc…
• Reviewing plan documents for possible exclusions
• Acting as the CH’s out of office (checking voicemail messages and emails)
• Will be responsible for consistency and accuracy on time-sensitive documents.
• Managing a large case load
• Using MS Word, Excel, Microsoft Outlook and other programs in preparation of correspondence and/or other documents

Experience and Qualifications:

• Associates degree or higher preferred
• 1-3 years of Subrogation/Reimbursement experience
• Must pass applicable test(s) administered by department manager (including the applicable qualification cards).
• Strong decision making abilities to determine recovery potential and proper reimbursement.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Must have ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to read, write and speak the English Language.
• Bilingual (preferred but not required).
• Paralegal Certificate (preferred but not required)

Working Conditions / Physical Demands:

Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines.

This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary.

External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.