The Phia Group, LLC · 2 months ago
Member Support Claims Specialist
Louisville , KY
Full-time
Onsite
Mid Level
$55K/yr - $65K/yr
4+ years expThe Phia Group is a service-oriented consultant that assists health plans nationwide and internationally. The Member Support Claims Specialist will be responsible for communicating with patients of contracted clients to reduce healthcare claims costs and manage claim disputes.
ConsultingFinancial ServicesInformation TechnologyLegal
Responsibilities
Manage a daily running inventory of claims or claim disputes
Help support Ad hoc Claim support across Provider Relations
Ability to handle sensitive timelines
Appropriately escalate client issues and or concerns
Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards
Contact facilities and providers to discuss charge adjustments, settlement and rationale
Contact facilities and explain benefits to resolve payment disputes
Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities
As needed, handle member inquires in accordance to their medical plan
Contact TPAs and/or patients to discuss and harvest necessary documentation
Communicate generally about process and next steps to TPAs and/or patients
Capture detailed notes on calls for future reference
Work with the Provider Relation’s Escalation team to ensure proper handling of complicated situations
Participate in on-going process improvement to develop efficiencies that streamline the handling of all cases
Entering and Reviewing referral information for incoming balance bill requests; ensuring accuracy and completeness for new files
Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA)
Qualification
Required
A minimum of four years' experience in a medical healthcare claims role
Computer literate, including Microsoft Office products
Strong data literacy skills with the ability to triage, wrangle, and interpret data sources
Proactive, persuasive, persistent, respectful, assertive
Excellent problem-solving skills
Ability to handle sensitive timelines
Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA)
Company
The Phia Group, LLC
The Phia Group, LLC, headquartered in Canton, Massachusetts, is an experienced provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets.
201-500 employees
Funding
Current Stage
Growth StageTotal Funding
unknownKey Investors
InTandem Capital PartnersWestView Capital Partners
2025-12-02Private Equity
2018-09-17Private Equity
Leadership Team
Peter Kotsifas, CPA
Chief Financial Officer
Recent News
2025-12-10
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