Sr. Claim Recovery Specialist

The Phia Group•Louisville, KY

9d•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, 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.

Requirements

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 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

Associates degree or higher preferred
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.
Being familiar with different case laws (with use of passionforsubro.com).
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 (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.