Sr. Claim Recovery Specialist

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 ie 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 families you can look forward to not only exceptional benefits for yourself but also being immersed in a company that was named one of USA Todays Top Workplaces for 2026 Meanwhile from a regional perspective The Boston Globe Courier Journal and Louisville Business First annually recognize our unwavering commitment to upholding an internal culture of inclusivity enjoyment and empathy for our valued employees by listing The Phia Group in their respective lists for the Top Places to Work Essential Duties and Responsibilities Calling adjusters and attorneys for statusNegotiating with attorneysBeing familiar with different case laws with use of passionforsubrocomDrafting mailing & faxing correspondenceCalling insurance carriers for claim information claim adjuster name phone fax & mailing addressProviding clients with accident details reduction requests etcReviewing plan documents for possible exclusionsActing as the CHs out of office checking voicemail messages and emailsWill be responsible for consistency and accuracy on time sensitive documentsManaging a large case loadUsing MS Word Excel Microsoft Outlook and other programs in preparation of correspondence andor other documentsExperience and Qualifications Associates degree or higher preferred1 3 years of SubrogationReimbursement experienceMust pass applicable tests administered by department manager including the applicable qualification cardsStrong decision making abilities to determine recovery potential and proper reimbursementMaintain confidentiality and comply with Health Insurance Portability and Accountability Act HIPAAMust have ability to define problems collect data establish facts and draw valid conclusionsAbility to read write and speak the English LanguageBilingual preferred but not requiredParalegal Certificate preferred but not requiredWorking 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 Base Salary 50000 65000