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Claim Specialist needed to combat rising healthcare costs and empower health plans! The Phia Group is a service-oriented consultant that assists health plans nationwide. We provide our clients with innovative cost-cutting solutions and innovative service offerings. We continue to enjoy growth thanks to our most valuable resource our talented and committed team.
Until recently, surprise medical bills were a leading cause of financial distress and bankruptcy for American families. Surprise billing occurs when a patient presents to an out-of-network medical provider through no fault of their own like in the case of an emergency and the patient becomes responsible for amounts beyond what their insurance pays. Thankfully, beginning in 2022 with the implementation of the No Surprises Act, the legislature effectively banned surprise billing, instead prescribing a system of negotiation and arbitration that health plans and providers must follow to resolve billing disputes.
The Claim Specialist will be responsible for supporting the team on all aspects of the No Surprises Act, including reviewing medical claims, keeping track of strict deadlines, drafting settlement agreements, and preparing submissions for Independent Dispute Resolution, among many other tasks. The candidate will also be expected to support the team on balance billing and overpayment matters as needed. This position requires someone that is proactive, persuasive, persistent, respectful, and assertive. The candidate must be comfortable multi-tasking and possess strong communication skills, both oral and written. The Phia Group is growing quickly and so the candidate must be comfortable in a dynamic fast-paced environment.
Essential Duties and Responsibilities include the following. Other duties may be assigned.
Experience and Qualifications
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.
Full Time
$70k-88k (estimate)
07/22/2023
05/16/2024
phiatech.com
Fairfax, VA
25 - 50
The job skills required for Claim Specialist include Microsoft Office, Billing, Communication Skills, etc. Having related job skills and expertise will give you an advantage when applying to be a Claim Specialist. That makes you unique and can impact how much salary you can get paid. Below are job openings related to skills required by Claim Specialist. Select any job title you are interested in and start to search job requirements.
If you are interested in becoming a Claim Specialist, you need to understand the job requirements and the detailed related responsibilities. Of course, a good educational background and an applicable major will also help in job hunting. Below are some tips on how to become a Claim Specialist for your reference.
Step 1: Understand the job description and responsibilities of an Accountant.
Quotes from people on Claim Specialist job description and responsibilities
The specialist reports and processes these claims by researching the policy and accumulating evidence regarding the claim.
01/14/2022: Bellingham, WA
They help analyze and investigate complicated insurance claims to help prevent fraud.
03/20/2022: Pierre, SD
Claims specialists must also compile reports and communicate regularly with supervisors and managers regarding the status of claims.
01/26/2022: Medford, OR
In some other cases, if necessary, calim specialists provide well-informed court testimonies.
01/27/2022: Fayetteville, NC
They must treat clients fairly and equitably, but also make sure claims are legitimate and reasonable.
01/30/2022: Johnstown, PA
Step 2: Knowing the best tips for becoming an Accountant can help you explore the needs of the position and prepare for the job-related knowledge well ahead of time.
Career tips from people on Claim Specialist jobs
Claims specialists are required to follow the California Health and Safety Code when accepting or denying claims.
01/16/2022: Fort Lauderdale, FL
As a claim specialist you may be occasionally must deal with hostile individuals in emotionally charged settings.
02/12/2022: Ventura, CA
Claim numbers may be formatted differently on different OPM documents.
03/03/2022: Anchorage, AK
Secure a license or relavant training to land a job as claim specialist.
02/26/2022: New York, NY
As a claim specialist it is obvious that you would be dealing with lots of information. Thus you must have knowledge of data management systems and processes.
03/15/2022: Shreveport, LA
Step 3: View the best colleges and universities for Claim Specialist.