Senior Liability Claims Adjuster (Senior Claims Adjuster)

The Phia Group provides 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.

Essential Duties and Responsibilities

Calling adjusters and attorneys for status

Negotiating with attorneys

Being familiar with different case laws (with use of passionforsubro.com)

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.

Using MS Word, Excel, Microsoft Outlook and other programs in preparation of correspondence and/or other documents

Experience and Qualifications

Associate degree or higher preferred

1-3 years of Subrogation/Reimbursement experience

Must pass applicable test(s) administered by department manager (including the applicable qualification cards).

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

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.

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.

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