Health Claim Investigation Representative

The Phia Group provides claim recovery services for health benefit plans, and they are seeking a Health Claim Investigation Representative to aid in recovering funds for medical bills. The role involves communicating with plan members and insurance carriers to gather necessary information for claims reimbursement.

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