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, on behalf of the health plan, seeks reimbursement from entities such as auto insurance or workers’ compensation carriers. The Claim Recovery Department notifies entities of reimbursement rights and negotiates recoveries. The WC Claim Recovery Specialist manages workers’ compensation files, communicates with attorneys, adjusters, and members regarding subrogation and reimbursement opportunities, coordinates with clients by phone and email to facilitate claim retractions and provide accident details. The company’s mission is to provide high‑quality yet affordable healthcare to American employees and their families, and it has been recognized as a USA Today Top Workplace for 2026 and by regional outlets such as The Boston Globe, Courier Journal, and Louisville Business First for its inclusive, enjoyable, and empathetic workplace 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

Qualifications

• 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 as work entails constant public contact through 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
• Must be self‑motivated and able to meet both internal and state‑issued deadlines
• Maintain confidentiality and comply with Health Insurance Portability and Accountability Act (HIPAA)
• Must meet regular attendance expectations based on agreed‑upon schedule
• Ability to define problems, collect data, establish facts, and draw valid conclusions

Skills

• Attention to detail
• Prioritization and multitasking
• Verbal and written communication
• Decision making
• Organizational abilities
• Interpersonal skills
• Administrative proficiency
• Telephone etiquette
• Writing proficiency
• Self‑motivation
• Problem definition and data collection
• Knowledge of state‑specific workers’ compensation laws and fee schedules
• Familiarity with TPS system

Pay

Salary: $55,000 base