Workers' Compensation Claim Recovery Specialist

🕒 October 21

🐎 Kentucky – Remote

🐎 Kentucky – Remote

💵 $55k / year

⏰ Full Time

🟡 Mid-level

🟠 Senior

👻 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 workers’ compensation files within the Claim Recovery Department • Communicate with attorneys, adjusters, members, clients, healthcare providers, and outside counsel regarding subrogation and reimbursement opportunities • Contact insurance carriers to obtain claim information, including claim numbers, adjuster details, and mailing addresses • Call adjusters and attorneys for status updates on accepted and appealed claims • Negotiate claim resolution with adjusters and attorneys • Maintain knowledge of state-specific case laws and fee schedules • Draft, mail, and fax correspondence • Monitor state-specific claims with outside counsel and state workers’ compensation boards • Ensure state-specific filing deadlines and recovery timelines are met • Provide clients with accident details, reduction requests, and related information • Review plan documents for potential exclusions • Correspond with plans regarding workers’ compensation funding status • Coordinate with healthcare providers to identify and secure overpayments • Ensure accuracy and consistency of time-sensitive documents • Update internal portals regarding retraction situations • Comply with state recovery statutes, including HIMP • Manage a large caseload while maintaining current claim status • Learn and manage work within The Phia Group’s TPS system

🎯 Requirements

• High School Diploma or higher preferred • Must pass applicable test(s) administered by department manager • Excellent attention to detail with the ability to prioritize multiple tasks • Excellent communication skills for constant public contact by telephone and written correspondence • Strong decision-making abilities to determine recovery potential and proper reimbursement • Outstanding organizational, interpersonal, and administrative skills • Excellent telephone, writing, and communication skills • Self-motivated and able to meet internal and state-issued deadlines • Maintain confidentiality and comply with HIPAA • Meet regular attendance expectations based on agreed-upon schedule • Ability to define problems, collect data, establish facts, and draw valid conclusions • Ability to perform essential job functions unaided or with reasonable accommodation • Extensive computer work and ability to operate office equipment including personal computer, copiers, and fax machines

🏖️ Benefits

• Exceptional benefits for employees • Company culture of inclusivity, enjoyment, and empathy • Reasonable accommodation for qualified individuals with disabilities

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