Workers' Compensation - Claim Recovery Specialist

About the role

The Phia Group provides claim recovery services for health benefit plans. When a health plan pays medical bills for its participants and another party should have been responsible, The Phia Group seeks reimbursement from entities such as auto insurance or workers’ compensation carriers. The Claim Recovery Department notifies entities of reimbursement rights and negotiates recoveries, focusing on recovering funds. The WC Claim Recovery Specialist manages workers’ compensation files within this department, communicating with attorneys, adjusters, and members about subrogation and reimbursement opportunities, coordinating with clients by phone and email to facilitate claim retractions and provide accident‑related details. The company’s mission is to deliver high‑quality, affordable healthcare to American employees and their families, and it has been recognized as a Top Workplace by USA Today (2026) and by regional outlets such as The Boston Globe, Courier Journal, and Louisville Business First for its inclusive, enjoyable, and empathetic culture.

Responsibilities

• Contact insurance carriers to obtain claim information, including claim numbers, adjuster contact details, and mailing addresses
• Call adjusters and attorneys to obtain status updates on accepted and appealed claims
• Negotiate with adjusters and attorneys regarding claim resolution
• Maintain knowledge of state‑specific case laws and fee schedules
• Draft, mail, and fax correspondence
• Monitor the status of state‑specific claims with outside counsel and state workers’ compensation boards
• Ensure all state‑specific filing deadlines 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 (self‑funded vs. fully funded)
• Coordinate with healthcare providers to identify and secure overpayments
• Ensure consistency and accuracy of time‑sensitive documents
• Update internal portals regarding retraction situations
• Comply with state recovery statutes, including HIMP, and ensure claims are submitted within applicable state timeline guidelines
• 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
• Must meet regular attendance expectations based on agreed‑upon schedule
• Maintain confidentiality and comply with HIPAA
• Ability to define problems, collect data, establish facts, and draw valid conclusions

Qualifications

• Excellent attention to detail with ability to prioritize multiple tasks
• Excellent communication skills (telephone, writing, and correspondence)
• Strong decision‑making abilities to determine recovery potential and proper reimbursement
• Outstanding organizational, interpersonal, and administrative skills
• Self‑motivated and able to meet internal and state‑issued deadlines

Pay

Salary: $55,000 base