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The Phia Group, LLC · 6 hours ago

Claims Specialist

Louisville, KY

Full-time

Onsite

New Grad, Entry Level

$50K/yr - $65K/yr

The Phia Group, LLC is a service-oriented consultant assisting health plans nationwide. The Claims Specialist will support the team on all aspects of the No Surprises Act, including reviewing medical claims and preparing submissions for Independent Dispute Resolution.

ConsultingFinancial ServicesInformation TechnologyLegal

Responsibilities

Manage a daily running inventory of unpaid claims or claim disputes

Review and prioritize claims based on processing criteria, timelines, client demands, and service level standards

Contact facilities and providers to discuss charge adjustments and rationale

Contact facilities and explain benefits to resolve payment disputes

Draft correspondence pertaining to settlement and negotiation efforts for providers and other entities

Capture detailed notes on calls for future reference

As needed, handle member inquires in accordance to their medical plan

Work with The Phia Group’s legal department to ensure escalation of claims

Participate in on-going process improvement to develop efficiencies that streamline the claim settlement process

Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA)

Qualification

Healthcare claims experienceNegotiation skillsBaccalaureate degreeMicrosoft Office proficiencyProactive attitudeMulti-tasking abilityRespectful demeanorPersistent natureAssertivenessCommunication skills

Required

Proactive, persuasive, persistent, respectful, and assertive

Comfortable multi-tasking

Strong communication skills, both oral and written

Comfortable in a dynamic fast-paced environment

Ability to properly handle confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA)

Preferred

Baccalaureate degree (BA/BS) from an accredited college or university

Experience in a medical healthcare claims role, preferably involving negotiation, or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting

Computer literate, including Microsoft Office products

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.

Founded in 1999