Sr. Claim Recovery Specialist

The Phia Group•Louisville, KY

2d•Onsite

About The Position

The Phia Group provides claim recovery services for health benefit plans. When a health benefit plan pays medical bills, and it's later discovered that someone else should have paid those medical bills, The Phia Group seeks to recover the funds on behalf of the health plan. The Senior Claims Recovery Specialist plays an important role in this effort by determining if another proper payer exists and pursuing fund reimbursement. The Phia Group's mission is to provide high-quality yet affordable healthcare to American employees and their families. Employees can look forward to exceptional benefits and being immersed in a company recognized as one of USA Today’s Top Workplaces for 2026. Additionally, The Boston Globe, Courier Journal, and Louisville Business First annually recognize The Phia Group's commitment to an internal culture of inclusivity, enjoyment, and empathy for its employees by listing the company among their Top Places to Work.

Requirements

Associates degree or higher preferred.
1-3 years of Subrogation/Reimbursement experience.
Must pass applicable test(s) administered by department manager (including 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 the ability to define problems, collect data, establish facts, and draw valid conclusions.
Ability to read, write, and speak the English language.

Nice To Haves

Bilingual (preferred but not required).
Paralegal Certificate (preferred but not required).

Responsibilities

Handling files for the Recovery Department.
Communicating with attorneys, adjusters, and plan participants to determine potential sources of recovery (e.g., auto insurance, workers compensation, first party coverage, third party coverage).
Communicating with clients (health benefit plan sponsors, employers, and claims administrators) via phone and email.
Performing additional tasks as needed to assist with the day-to-day activities of the Recovery Department.
Calling adjusters and attorneys for status updates.
Negotiating with attorneys.
Drafting, mailing, and faxing correspondence.
Calling insurance carriers for claim information (claim #, adjuster name, phone, fax, and mailing address).
Providing clients with accident details, reduction requests, etc.
Reviewing plan documents for possible exclusions.
Acting as the CH's out of office representative (checking voicemail messages and emails).
Ensuring consistency and accuracy on time-sensitive documents.
Managing a large caseload.
Using MS Word, Excel, Microsoft Outlook, and other programs in preparation of correspondence and/or other documents.