[Hiring] Claims Specialist @The Phia Group

Role Description

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. The Claims Specialist will be responsible for supporting the team on all aspects of the No Surprises Act, including:

• Reviewing medical claims
• Keeping track of strict deadlines
• Drafting settlement agreements
• Preparing submissions for Independent Dispute Resolution
• Supporting the team on balance billing and overpayment matters as needed

This position requires someone that is proactive, persuasive, persistent, respectful, and assertive. The candidate must be comfortable multi-tasking and possess strong communication skills, both oral and written. The Phia Group is growing quickly and so the candidate must be comfortable in a dynamic fast-paced environment.

Essential Duties and Responsibilities include the following. Other duties may be assigned:

• Manage a daily running inventory of unpaid claims or claim disputes
• Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards
• Contact facilities and providers to discuss charge adjustments and rationale
• Contact facilities and explain benefits to resolve payment disputes
• Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities
• Capture detailed notes on calls for future reference
• Handle member inquiries in accordance to their medical plan as needed
• Work with The Phia Group’s legal department to ensure escalation of claims
• Participate in ongoing process improvement to develop efficiencies that streamline the claim settlement process
• Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA)

Qualifications

• Preferred: Baccalaureate degree (BA/BS) from an accredited college or university
• Preferred: Experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting
• Computer literate, including Microsoft Office products

Requirements

• 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 - $65,000 / year