Job Description

The Phia Group provides, amongst other things, claim recovery services for health benefit plans. When a health benefit plan pays medical bills, and we later discover someone else should have paid those medical bills, The Phia Group – on behalf of the health plan – will seek to recover the funds. The Case Investigator plays an important role in this effort, by determining whether another proper payer exists, and obtaining the details needed to pursue fund reimbursement.

The Health Claim Investigation Representative is responsible for communicating with plan members (insured participants) to determine potential sources of recovery (i.e. auto insurance, workers compensation, first party coverage, third party coverage, etc.). You will also be in contact with insurance carriers to collect adjuster and claim information while balancing communication with clients (health benefit plan sponsors, employers, and claims administrators) via phone and email.

At The Phia Group, whose mission is to provide high quality yet affordable healthcare to American employees and their families, you can look forward to not only unparalleled benefits for yourself but also being immersed in a company that was named one of USA Today’s Top Workplaces for 2025 Meanwhile, from a regional perspective, both The Boston Globe and Louisville Business First also recognized our unwavering commitment to upholding an internal culture of inclusivity, enjoyment, and empathy for our valued employees by listing The Phia Group in their respective lists for the Top Places to Work in 2025.

Note: This is a hybrid position.

Essential Duties and 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

Experience and Qualifications

• 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

The Phia Group’s Commitment to Diversity

The Phia Group is committed to creating a diverse environment and we are proud to be an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, gender, gender identity or expression, sexual orientation, national origin, genetics, disability, age, or veteran status. The Phia Group is also committed to compliance with all fair employment practices regarding citizenship and immigration status.

Working Conditions / Physical Demands

Sitting at workstation for prolong periods of time. Extensive computer work. Workstation may be exposed to overhead fluorescent lighting and air conditioning. Fast paced work environment. Operates office equipment including personal computer, copiers, and fax machines.

This job description is not intended to be and should not be construed as an all-inclusive list of all the responsibilities, skills or working conditions associated with the position. While it is intended to accurately reflect the position activities and requirements, the company reserves the right to modify, add or remove duties and assign other duties as necessary.

External and internal applicants, as well as position incumbents who become disabled as defined under the Americans with Disabilities Act, must be able to perform the essential job functions (as listed here) either unaided or with the assistance of a reasonable accommodation to be determined by management on a case by case basis.

Salary: $47,000 - $50,000