Claims Specialist

Job not on LinkedIn

🔥 47 minutes ago

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $50k - $65k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

📋 Claims Specialist

👻 Ghost score 0%

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The Phia Group, LLC

WebsiteLinkedInAll Job Openings

201 - 500 employees

Founded 2000

💼 Consulting

🏥 Healthcare

🛡️ Insurance

💰 Private Equity Round on 2018-09

Consulting • Healthcare • Insurance

The Phia Group, LLC is a dedicated provider of healthcare cost containment solutions, focusing on empowering self-funded health plans to maximize benefits and minimize costs. Through a comprehensive suite of services, including subrogation and recovery, claims negotiation, and cost transparency initiatives, The Phia Group aims to help employers and families navigate the complexities of healthcare with advocacy and expertise. Their commitment to improving healthcare accessibility and affordability sets them apart in the industry.

📋 Description

• 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 • Handle member inquiries in accordance with their medical plan as needed • Work with The Phia Group’s legal department to ensure escalation of claims • Participate in ongoing process improvement to develop efficiencies that streamline the claim settlement process • Support the team on No Surprises Act matters, including reviewing medical claims, tracking strict deadlines, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution • Support balance billing and overpayment matters as needed

🎯 Requirements

• Preferred: Baccalaureate degree (BA/BS) from an accredited college or university • Preferred: 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 • Strong oral and written communication skills • Ability to multitask in a dynamic, fast-paced environment • Ability to handle confidential information in accordance with HIPAA • Ability to perform essential job functions unaided or with reasonable accommodation • Ability to sit at a workstation for prolonged periods and perform extensive computer work

🏖️ Benefits

• Exceptional benefits • Inclusive, enjoyable, and empathetic company culture • Recognition as a USA Today Top Workplace for 2026 • Recognition by The Boston Globe, Courier Journal, and Louisville Business First as a Top Place to Work

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