[Hiring] Claim Appeals Specialist @The Phia Group

Role Description

The Phia Group allows employers who manage their own health benefit plans to submit complicated appeals regarding denied claims to The Phia Group, and we help ensure that payable claims get paid, while proper denials remain in place. To ensure these appeals and claims are handled properly, our Plan Appointed Claim Evaluator (“PACE”) team needs dedicated, organized, and passionate members.

As a PACE Claim Appeal Specialist, you will be responsible for:

• Maintaining status of client documents
• Reviewing clients' summary plan documents, stop loss policies, and employee handbooks
• Inventorying and auditing all incoming final internal appeals and external appeals

Qualifications

• Minimum of 2 years of experience with employer benefit plan documents and reviewing of medical appeals
• Ability to utilize various case management software for the purpose of tracking appeals
• Excellent organizational skills and attention to details
• Excellent verbal and written communication skills
• Advanced knowledge of Microsoft Excel
• Ability to multi-task with a high level of attention to detail
• Handles stressful situations and deadline pressures well
• Plans and carries out responsibilities with minimal direction

Requirements

• Maintain an inventory of client documents required and received
• Coordinate and review employer benefit plan documents and stop loss policy
• Communicate with clients regarding receipt and status of appeals
• Receive, audit, and review all submitted final internal medical claims appeals and external medical claims appeals
• Prepare and summarize appeal content
• Assign appeal for review and response
• Create and coordinate timely status updates and responses to clients

Benefits

• Exceptional benefits for employees
• Named one of USA Today’s Top Workplaces for 2026
• Recognized by The Boston Globe, Courier Journal, and Louisville Business First for commitment to inclusivity and employee satisfaction

Working Conditions / Physical Demands

• Sitting at workstation for prolonged 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

Salary

$50,000 - $60,000