Workers' Compensation - Claim Recovery Specialist

Job Description

Job Description

The Phia Group provides claim recovery services for health benefit plans. When a health plan pays medical bills for its participants (employees and their families) and it is later determined that another party should have been responsible for those expenses, The Phia Group, on behalf of the health plan, seeks reimbursement from the appropriate entity, such as an auto insurance or workers’ compensation carrier.

The Claim Recovery Department plays a key role in this process by notifying entities of reimbursement rights and negotiating recoveries for clients. The department’s primary focus is recovering funds.

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.

At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their families, you can look forward to not only exceptional benefits for yourself but also being immersed in a company that was named one of USA Today’s Top Workplaces for 2026. Meanwhile, from a regional perspective, The Boston Globe, Courier Journal, and Louisville Business First annually recognize our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees by listing The Phia Group in their respective lists for the Top Places to Work.

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.

Experience and 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

Working Conditions / Physical Demands

Sitting at workstation for prolong 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.

This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary .

External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case-by-case basis

Salary: $55,000 base