Sr. Claim Recovery Specialist

Job Description

Job Description

The Phia Group provides, amongst other things, claim recovery services for health benefit plans. When a health benefit plan pays medical bills, and we later discover 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.

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.

Tasks Include : Handling files for the Recovery Department. Communicating with attorneys, adjusters and plan participants (insured participants) to determine potential sources of recovery (i.e. auto insurance, workers compensation, first party coverage, third party coverage, etc.). Communicating with clients (health benefit plan sponsors, employers, and claims administrators) via phone and email. Performing additional tasks (on an as-needed basis) to assist with the day-to-day activities of the Recovery Department.

Essential Duties and Responsibilities:

• Calling adjusters and attorneys for status
• Negotiating with attorneys
• Being familiar with different case laws (with use of passionforsubro.com)
• Drafting, mailing & faxing correspondence
• Calling insurance carriers for claim information (claim #, adjuster name, phone, fax & 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)
• Will be responsible for consistency and accuracy on time-sensitive documents.
• Managing a large case load
• Using MS Word, Excel, Microsoft Outlook and other programs in preparation of correspondence and/or other documents

Experience and Qualifications:

• Associates degree or higher preferred
• 1-3 years of Healthcare Subrogation/Reimbursement experience
• 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 ability to define problems, collect data, establish facts, and draw valid conclusions.
• Ability to read, write and speak the English Language.
• Bilingual (preferred but not required).
• Paralegal Certificate (preferred but not required)

Working Conditions / Physical Demands:

Office-based work environment requiring regular computer use and extended periods of computer-based work. The position operates in a fast-paced environment and may require the use of standard office equipment. Reasonable accommodations may be provided to enable qualified individuals to perform the essential functions of the position.

Working Arrangement / Work From Home:

This position is primarily office-based during the initial training and onboarding period. Employees are generally required to work in the office for their first 90 days to ensure they receive appropriate training, support, and development of the skills needed to perform the role independently. Following this period, eligible employees may be considered for a work-from-home arrangement based on demonstrated performance, ability to work independently, and business needs. Exceptions to the 90-day requirement may be considered for candidates with significant, directly relevant experience.

Work-from-home arrangements are subject to company policy and approval. Reasonable accommodations will be considered in accordance with applicable law.

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.

Base Salary: $50,000 - $65,000