Health Claim Investigation Representative

The Phia Group, LLC provides claim recovery services for health benefit plans and is seeking a Health Claim Investigation Representative. This role involves communicating with plan members and insurance carriers to determine sources of recovery and assist in fund reimbursement efforts. Responsibilities Calling members for accident details Drafting, mailing & faxing correspondence Calling insurance carriers for claim information (claim #, adjuster name, phone, fax & mailing address) Providing clients with accident details, payment ledgers, police reports, etc Reviewing plan documents for possible exclusions Verifying first party, workers’ compensation, third party and/or attorney representation and properly promoting and/or transferring the file to the appropriate CRS Will be responsible for consistency and accuracy on time-sensitive documents Working on a team to efficiently handle tasks and keep the team up to date Using MS Word, Excel, Microsoft Outlook and other programs in preparation of correspondence and/or other documents Skills Excellent attention to detail with the ability to multi-task Excellent communication skills High level of proficiency using Microsoft Word and Excel required Outstanding organizational, interpersonal, and administrative skills Excellent telephone, writing, and communication skills Must be self-motivated and able to meet deadlines under pressure Must have the ability to work as part of a team, as well as to work independently Company Overview 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. It was founded in 1999, and is headquartered in Braintree, Massachusetts, USA, with a workforce of 201-500 employees. Its website is