The Phia Group is a service-oriented consultant that assists health plans nationwide. We provide our clients with innovative cost-cutting solutions and innovative service offerings. We continue to enjoy growth thanks to our most valuable resource – our talented and committed team.

The Reimbursement Specialist plays a pivotal role within our department, ensuring the effective management and resolution of pre-payment and post-payment claims. This dynamic position requires a detailed-oriented individual with excellent communication skills, who is adept at navigating complex problems and prioritizing tasks based on urgency and client demands. The Reimbursement Specialist is instrumental in liaising with customers and service providers, managing sensitive correspondence, and contributing to the continuous improvement of our claims process.

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.

Essential Duties and Responsibilities include the following. Other duties may be assigned.

Efficiently manage a daily inventory of unpaid claims, claims awaiting repricing, and customer tickets. Review and prioritize claims by assessing timelines, client demands, and adherence to service level standards, ensuring optimal service delivery. As needed, engage in direct communication with healthcare facilities, providers and clients to negotiate charge adjustments, discuss settlement options, and clarify the rationale behind financial decisions. Draft, review, and manage correspondence and agreements related to settlement efforts, ensuring accuracy and compliance with relevant standards. Diligently capture and record detailed notes from all communications for future reference, maintaining accurate and up-to-date information in our operating system. Collaborate with various departments within The Phia Group to ensure claims are handled efficiently and in accordance with established policies. Actively participate in process improvement initiatives aimed at streamlining the claim settlement process, contributing to the development of more efficient operational procedures. Engage in the development and testing of The Phia Group's core applications, providing valuable feedback and insights to enhance system functionality and user experience. Handle all confidential information with the utmost care, ensuring compliance with the Health Insurance Portability and Accountability Act (HIPAA) and maintaining the integrity and privacy of sensitive data.

Experience and Qualifications

At least three (3) years’ experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting. Bachelor’s degree (B.A. or B.S.) from an accredited college or university is preferred. Computer literate, including Microsoft Office products.

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.