Sr. Claim Recovery Specialist

2 weeks ago

Louisville, United States The Phia Group Full time
Job DescriptionJob Description

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.

  • Claims Specialist

    Found in: Appcast Linkedin GBL C2 - 2 hours ago

    Louisville, United States EPITEC Full time

    Position Description:Primary Workers Compensation Claims Handler at the Plant with a focus on excellent customer service, quality claims handling, and loss cost management. Plant-based position with hybrid work schedule to be considered.Skills Required:Analyze and process complex or technically difficult workers compensation claims by investigating and...

  • Claims Specialist

    1 week ago

    Louisville, United States Onpoint Full time

    Claims Specialist The Claims Specialist has the responsibility for processing service claims made by the OnPoint warranty service network. The position works closely with the OnPoint Service and Claims Management teams to ensure our network maintains the desired lost cost ratios. This position is located in the Corporate office in Louisville, KY. Primary...

  • Claim Specialist

    1 week ago

    Louisville, United States CareerBuilder Full time

    Claim Specialist needed to combat rising healthcare costs and empower health plans! 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...

  • Claim Specialist

    1 week ago

    Louisville, United States The Phia Group Full time

    Claim Specialist needed to combat rising healthcare costs and empower health plans! 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...

  • Peer Support Specialist/ Community Support Associate

    1 week ago

    Louisville, United States Green House Recovery And Rehabilitation Full time

    Job DescriptionJob DescriptionBenefits/PerksCompetitive CompensationGreat Work EnvironmentJob SummaryWe are seeking a Peer Support Specialist/CSA to join our team! As the Peer Support Specialist, you will  direct, coordinate, and manage the activities of a comprehensive mental health program , including  connect clients with resources and services to help...

  • Peer Support Specialist/ Community Support Associate

    1 week ago

    Louisville, United States Green House Recovery And Rehabilitation Full time

    Job DescriptionJob DescriptionBenefits:Competitive salaryBenefits/PerksCompetitive CompensationGreat Work EnvironmentJob SummaryWe are seeking a Peer Support Specialist/CSA to join our team! As the Peer Support Specialist, you will direct, coordinate, and manage the activities of a comprehensive mental health program , including connect clients with...

  • Workers' Compensation Specialist

    12 hours ago

    Louisville, United States Acro Service Corp Full time

    Job Title:- Workers Compensation SpecialistDuration:- 84- months or 7 years position (May go Longer) Work Hours: 8:00 AM to 04:30 PMJob Description:Position Description:Primary Workers' Compensation Claims Handler at the Plant with a focus on excellent customer service, quality claims handling, and loss cost management. Plant-based position with hybrid work...

  • Workers' Compensation Specialist

    Found in: Appcast US C2 - 6 hours ago

    Louisville, United States Acro Service Corp Full time

    Job Title:- Workers Compensation SpecialistDuration:- 84- months or 7 years position (May go Longer) Work Hours: 8:00 AM to 04:30 PMJob Description:Position Description:Primary Workers' Compensation Claims Handler at the Plant with a focus on excellent customer service, quality claims handling, and loss cost management. Plant-based position with hybrid work...

  • Workers' Compensation Specialist

    Found in: Appcast Linkedin GBL C2 - 2 hours ago

    Louisville, United States Acro Service Corp Full time

    Job Title:- Workers Compensation SpecialistDuration:- 84- months or 7 years position (May go Longer) Work Hours: 8:00 AM to 04:30 PMJob Description:Position Description:Primary Workers' Compensation Claims Handler at the Plant with a focus on excellent customer service, quality claims handling, and loss cost management. Plant-based position with hybrid work...

  • Claims Coordinator

    Found in: Resume Library US A2 - 1 week ago

    Louisville, Kentucky, United States PPL Corporation Full time

    Company Summary Statement : As one of the largest investor-owned utility companies in the United States, PPL Corporation (NYSE: PPL), is committed to creating long-term, sustainable value for our 3.5 million customers, our shareowners and the communities we serve. Our high-performing regulated utilities — PPL Electric Utilities, Louisville Gas and...

  • FEMA Disaster Recovery

    1 week ago

    Louisville, United States RealStreet Full time

    In support of FEMA's Public Assistance (PA) program, we are actively searching for highly qualified and experienced candidates to support disaster recovery efforts. RealStreet is seeking architectural, engineering and construction (AEC) professionals for the following roles: Accountant Appraiser Archaeologist Architect Architectural...

  • FEMA Disaster Recovery

    Found in: Appcast US C2 - 1 week ago

    Louisville, United States RealStreet Full time

    In support of FEMA's Public Assistance (PA) program, we are actively searching for highly qualified and experienced candidates to support disaster recovery efforts. RealStreet is seeking architectural, engineering and construction (AEC) professionals for the following roles: Accountant Appraiser Archaeologist Architect Architectural...

  • AR Specialist

    2 weeks ago

    Louisville, United States Ellis and Badenhausen Ortho Full time

    Job DescriptionJob DescriptionMain FunctionReports directly to the Billing Manager and responsible for submitting claims and statements to third-party payers and guarantors. Maintains correspondence regarding billing questions and fields calls regarding billing. Works on reducing company AR. Collects on insurance and patient balances. Responsible for...

  • Workers' Compensation Claim Adjuster

    Found in: Resume Library US A2 - 2 days ago

    Louisville, Kentucky, United States CCMSI Full time

    Overview: At CCMSI, we look for the best and brightest talent to join our team of professionals. As a leading Third Party Administrator in self-insurance services, we are united by a common purpose of delivering exceptional service to our clients. As an Employee-Owned Company, we focus on developing our staff through structured career development programs,...

  • Insurance Customer Support Specialist

    2 weeks ago

    Louisville, United States Palacio Miller Insurance Agency Full time

    Job DescriptionJob DescriptionInsurance Customer Support Specialist Job Summary: We are looking for a customer support specialist to join our team and provide excellent service to our clients in the property and casualty insurance industry. Responsibilities include managing client communications, conducting policy reviews, nurturing key relationships, and...

  • Pay and Tax Specialist

    2 days ago

    Louisville, United States Icon Information Consultants Full time

    Pay and Tax Specialist #24-02926 Job Title: Pay and Tax Specialist Location: Houston, TX 77079 End-Client: Large Oil & Gas Company Pay: $30 - $35.47/hr. Benefits: Comprehensive benefits (401K, Health, Dental, and Vision) through Icon Consultants are available) Length of Assignment: 7 – months possible to extend  Role...

  • Pay and Tax Specialist

    5 days ago

    Louisville, United States Icon Information Consultants Full time

    Pay and Tax Specialist #24-02926 Job Title: Pay and Tax Specialist Location: Houston, TX 77079 End-Client: Large Oil & Gas Company Pay: $30 - $35.47/hr. Benefits: Comprehensive benefits (401K, Health, Dental, and Vision) through Icon Consultants are available) Length of Assignment: 7 – months possible to extend  Role...

  • Electronic Health Record IT Specialist

    1 week ago

    Louisville, United States The Home Of The Innocents Inc Full time

    1100 E Market St, Louisville, KY 40206, USA Req #405 Friday, April 5, 2024 Join Home of the Innocents (HOTI), a non-profit dedicated to supporting children and families in our community. Our mission is to enrich lives with hope, health, and happiness. As one of only two certified Sanctuary Organizations in Kentucky, we prioritize safety and recovery through...

  • Loan Servicing Specialist

    1 week ago

    Louisville, United States CareerBuilder Full time

    Responsible for all phases of the collection process to preserve the Credit Union's assets by monitoring overdrawn, delinquent, and charged-off accounts, collecting payments and recovering collateral in a timely manner to minimize losses. Project a friendly and professional attitude while assisting members with servicing existing loans and supporting the...

  • Sr. Program Manager

    1 week ago

    Louisville, United States United Staff Source Full time

    About the job Sr. Program Manager This role is responsible for sharing the accountability of the program's performance with a peer Senior Program Manager. The peer manager will concentrate mainly on managing the internal operations of the Document Specialists and (Non-Clinical) Case Manager team. Meanwhile, this role will primarily handle external program...