[Hiring] Workers' Compensation Claim Recovery Specialist @The Phia Group

Role Description

The WC Claim Recovery Specialist manages workers’ compensation files within the Claim Recovery Department by communicating with attorneys, adjusters, and members regarding potential subrogation and reimbursement opportunities. This role also involves frequent communication with clients by phone and email to coordinate reimbursement negotiations, facilitate the retraction of previously paid claims, and provide accident-related details.

Key Responsibilities:

• Contact insurance carriers to obtain claim information, including claim numbers, adjuster contact details, and mailing addresses.
• Call adjusters and attorneys to obtain status updates on accepted and appealed claims.
• Negotiate with adjusters and attorneys regarding claim resolution.
• Maintain knowledge of state-specific case laws and fee schedules.
• Draft, mail, and fax correspondence.
• Monitor the status of state-specific claims with outside counsel and state workers’ compensation boards.
• Ensure all state-specific filing deadlines are met.
• Provide clients with accident details, reduction requests, and related information.
• Review plan documents for potential exclusions.
• Correspond with plans regarding workers’ compensation funding status (self-funded vs. fully funded).
• Coordinate with healthcare providers to identify and secure overpayments.
• Ensure consistency and accuracy of time-sensitive documents.
• Update internal portals regarding retraction situations.
• Comply with state recovery statutes, including HIMP, and ensure claims are submitted within applicable state timeline guidelines.
• Manage a large caseload while maintaining current claim status.
• Learn and manage work within The Phia Group’s TPS system.

Qualifications

• High School Diploma or higher preferred.
• Must pass applicable test(s) administered by department manager.
• Excellent attention to detail with the ability to prioritize multiple tasks.
• Excellent communication skills as work entails constant public contact through telephone and written correspondence.
• Strong decision-making abilities to determine recovery potential and proper reimbursement.
• Outstanding organizational, interpersonal, and administrative skills.
• Excellent telephone, writing, and communication skills.
• Must be self-motivated and able to meet both internal and state issued deadlines.
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA).
• Must meet regular attendance expectations based on agreed-upon schedule.
• Must have ability to define problems, collect data, establish facts, and draw valid conclusions.

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.

Benefits

• Exceptional benefits for employees.
• Recognized as one of USA Today’s Top Workplaces for 2026.
• Listed in the Top Places to Work by The Boston Globe, Courier Journal, and Louisville Business First.

Salary

$55,000 base