The Phia Group provides, amongst other things, claim recovery services for health benefit plans. When a health benefit plan pays medical bills for its plan participants (employees and their families), 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 from the appropriate entity (such as auto insurance or workers’ compensation carriers).

The Claim Recovery Department plays an important role in this effort, as they are responsible for notifying entities of reimbursement rights and negotiating recovery for our clients. The department’s main focus is recovering funds and ensuring all responsible parties are made aware of the Plan’s potential reimbursement rights.

The Notice Specialist will maintain files with attorney representation for the Claim Recovery Specialist Department where no claims have been paid in a “hands off” workflow, placing appropriate parties on notice, and responding to correspondence received on files. Minimal communication is done with clients, however may be necessary with client’s who are requesting accident details to potentially process claims.

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.

Key Responsibilities

Providing documentation of reimbursement rights. Responding to incoming correspondence from attorneys and adjusters. Being familiar with case law (navigating myphia), and capable of responding to attorney correspondence refuting plan rights. Drafting, mailing & faxing correspondence Ensuring all state filing deadlines are met on a per state basis if plan is named in litigation documents. Providing clients with accident details, reduction requests, etc. Reviewing plan documents for possible exclusions Will be responsible for consistency and accuracy on time-sensitive documents and meeting any litigation deadlines or statute of limitations. Maintaining a large case load Learning and managing work in The Phia Group’s TPS system Ensuring cases are transferred to Contested Liability Recovery Specialist II when applicable thresholds are met.

Experience and Qualifications

Associate’s degree or higher preferred 1-3 years of experience in the subrogation field Must pass applicable test(s) administered by department manager Excellent attention to detail with the ability to prioritize multiple tasks. Excellent communication skills as work entails constant public contact through telephone and written correspondence. Strong decision-making abilities to determine recovery potential and proper reimbursement. Outstanding organizational, interpersonal, and administrative skills. Excellent telephone, writing, and communication skills. Must be self-motivated and able to meet both internal and state issued deadlines. Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA). Must meet regular attendance expectations based on agreed-upon schedule. Must have ability to define problems, collect data, establish facts, and draw valid conclusions. Ability to read, write and speak the English Language.

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