Healthcare Attorney (Canton, MA - Hybrid)

The Phia Group•Canton, MA

1d•$90,000 - $110,000•Hybrid

About The Position

The Phia Group, LLC is a thriving, service-oriented company headquartered in Canton, Massachusetts. As consultants, we represent health plans nationwide, providing our clients with innovative cost-containment solutions through our unique service offerings. As a result of our most valuable resource, our talented and committed team, we continue to enjoy high levels of growth. Now, we seek to add another Health Benefits Attorney to our team. We are currently seeking a full-time Healthcare Attorney with professional experience in the healthcare industry or in similar industries to solve complex issues presented by employers, their health plans, and those entities that service them. The Health Benefits Attorney will play an instrumental role in supporting our consulting services and the continued growth and expansion of our business. This individual will work closely with other attorneys and consultants on our legal team, providing support on consulting, transactional, regulatory, and compliance matters. 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 unparalleled benefits for yourself but also being immersed in a company that was named one of USA Todays Top Workplaces for 2025 . Meanwhile, from a regional perspective, both The Boston Globe and Louisville Business First also recognized 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 in 2025. Note: This is a hybrid schedule and can provide a flexible teleworking schedule if appropriate.

Requirements

Juris doctor from an accredited law school and admittance to a state bar (active)
1+ year of experience in the healthcare industry or in similar industries preferred (i.e., employment law, insurance law, disability law, workers compensation law)
Knowledge of the latest developments in health law, including a working understanding of the ACA, ERISA, MHPAEA, and HIPAA
Superior legal writing, analytical, and proofreading skills, as well as strong attention to detail
Outstanding organizational, interpersonal, and negotiation skills
Ability to work collaboratively or independently as needed, and to work sensitively with confidential matters
Ability to effectively communicate and interact with various positions throughout our organization as well as with clients
Ability to successfully manage multiple projects, whether large or small, complex or simple, simultaneously
Ability to participate effectively and confidently in client phone calls, including in occasional video conference calls
Ability to anticipate issues and create and implement methods for optimizing results and minimizing risks
Ability to develop a deep understanding of the business and our operational goals
Comfortable working in a fast-paced environment
High level of proficiency using Microsoft Word, Excel and Outlook
Must be self-motivated and able to meet deadlines under pressure

Nice To Haves

Excellent academic credentials
Strong preference for experience working with health plans, third-party administrators, and/or health insurance carriers
Familiarity with administrative rules published by relevant federal agencies, including HHS, the DOL, and the IRS
Knowledge of CMS billing and payment rules and processes, or medical coding generally
Confidence in public speaking
Willingness to travel

Responsibilities

Manage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly in self-funded and ERISA-regulated plans
Evaluate benefit exclusions, plan document terms, and medical necessity disputes to determine appropriate claim outcomes
Coordinate with applicable vendors to ensure timely and accurate facilitation of independent clinical reviews
Review determination letters, appeal responses, and other member/provider-facing communications to ensure legal sufficiency and regulatory compliance
Support internal audits, agency audits, corrective action plans, and external regulator or client requests, ensuring regulatory compliance
Conduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice, including analyses to our legal team for internal use
Review healthcare industry contracts
Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance
Communicate with health plan administrators and other healthcare industry entities, including by phone, video conference, or in person; answer questions regarding the administration of compliant health plans; explain applicable law or health plan terms clearly and concisely
Draft ERISA and ACA-compliant health plan documents, including MHPAEA required reports
Assist in resolving disputes between various players in the healthcare industry
Provide a thorough analysis of health plans and other related documents; provide a summary of findings to our legal team
Other duties as assigned