Health Benefit Plan Consulting Attorney

The Phia Group, LLC; Canton (MA); Hybrid; USD 90,000 - 110,000; Full time

Job summary

The Phia Group, LLC in Canton, MA is seeking a full-time Healthcare Attorney with experience in health plans and ERISA to support consulting, regulatory, and compliance matters.

The position emphasizes collaboration with attorneys and consultants to solve complex issues for employers and their health plans, including regulatory and compliance tasks. This is a hybrid schedule with flexible teleworking options when appropriate.

Qualifications

• Juris doctor from an accredited law school and active state bar.
• 1+ year healthcare industry experience preferred.
• Knowledge of ACA, ERISA, MHPAEA, and HIPAA.
• Strong legal writing, analytical and proofreading skills, with attention to detail.

Responsibilities

• Manage and support reviews of appeals, grievances, and complex claims issues for self-funded/ERISA plans.
• Evaluate benefits, plan terms, and medical necessity disputes to determine outcomes.
• Coordinate with vendors for independent clinical reviews.
• Review determination letters, appeal responses, and communications for regulatory compliance.
• Support audits and regulatory requests to ensure compliance.
• Draft consulting memoranda and provide analyses to the legal team.
• Review healthcare industry contracts and respond to client inquiries regarding rules and compliance.
• Communicate with health plan administrators via phone, video, or in person.
• Draft ERISA and ACA-compliant health plan documents, including MHPAEA reports.
• Assist in resolving disputes among healthcare industry stakeholders.
• Provide summaries of findings to the legal team.

Skills

Legal writing

Analytical skills

Attention to detail

Organization

Interpersonal skills

Negotiation

Communication

Deadline management

MS Word/Excel/Outlook

Education

Juris doctor

Bar admission (active)

Tools

Microsoft Word

Microsoft Excel

Outlook

Job description

The Phia Group, LLC is a thriving, service-oriented company headquartered in Canton, Massachusetts. As consultants, we represent health plans nationwide, providing our clients with innovative cost-containment solutions through our unique service offerings. As a result of our most valuable resource, our talented and committed team, we continue to enjoy high levels of growth. Now, we seek to add another Health Benefits Attorney to our team.

We are currently seeking a full-time Healthcare Attorney with professional experience in the healthcare industry or in similar industries to solve complex issues presented by employers, their health plans, and those entities that service them. The Health Benefits Attorney will play an instrumental role in supporting our consulting services and the continued growth and expansion of our business. This individual will work closely with other attorneys and consultants on our legal team, providing support on consulting, transactional, regulatory, and compliance matters.

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 exceptional benefits for yourself but also being immersed in a company that was named one of USA Today’s Top Workplaces for 2026. Meanwhile, from a regional perspective, The Boston Globe, Courier Journal, and Louisville Business First annually recognize 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.

Note: This is a hybrid schedule and can provide a flexible teleworking schedule if appropriate.

Essential Duties

• Manage and support reviews of member and provider appeals, grievances, and complex claims issues, particularly in self-funded and ERISA-regulated plans
• Evaluate benefit exclusions, plan document terms, and medical necessity disputes to determine appropriate claim outcomes
• Coordinate with applicable vendors to ensure timely and accurate facilitation of independent clinical reviews
• Review determination letters, appeal responses, and other member/provider-facing communications to ensure legal sufficiency and regulatory compliance
• Support internal audits, agency audits, corrective action plans, and external regulator or client requests, ensuring regulatory compliance
• Conduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice, including analyses to our legal team for internal use
• Review healthcare industry contracts
• Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance
• Communicate with health plan administrators and other healthcare industry entities, including by phone, video conference, or in person; answer questions regarding the administration of compliant health plans; explain applicable law or health plan terms clearly and concisely
• Draft ERISA and ACA-compliant health plan documents, including MHPAEA required reports
• Assist in resolving disputes between various players in the healthcare industry
• Provide a thorough analysis of health plans and other related documents; provide a summary of findings to our legal team
• Other duties as assigned

Minimum Qualifications

• Juris doctor from an accredited law school and admittance to a state bar (active)
• 1+ year of experience in the healthcare industry or in similar industries preferred (i.e., employment law, insurance law, disability law, workers’ compensation law)
• Knowledge of the latest developments in health law, including a working understanding of the ACA, ERISA, MHPAEA, and HIPAA
• Superior legal writing, analytical, and proofreading skills, as well as strong attention to detail
• Outstanding organizational, interpersonal, and negotiation skills
• Ability to work collaboratively or independently as needed, and to work sensitively with confidential matters
• Ability to effectively communicate and interact with various positions throughout our organization as well as with clients
• Ability to successfully manage multiple projects, whether large or small, complex or simple, simultaneously
• Ability to participate effectively and confidently in client phone calls, including in occasional video conference calls
• Ability to anticipate issues and create and implement methods for optimizing results and minimizing risks
• Ability to develop a deep understanding of the business and our operational goals
• Comfortable working in a fast-paced environment
• High level of proficiency using Microsoft Word, Excel and Outlook
• Must be self-motivated and able to meet deadlines under pressure

Preferred Qualifications

• Excellent academic credentials
• Strong preference for experience working with health plans, third-party administrators, and/or health insurance carriers
• Familiarity with administrative rules published by relevant federal agencies, including HHS, the DOL, and the IRS
• Knowledge of CMS billing and payment rules and processes, or medical coding generally
• Confidence in public speaking
• Willingness to travel

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

This position requires sitting at a workstation for prolong periods of time (with reasonable breaks as needed) and extensive computer work. The workstation may be exposed to overhead fluorescent lighting and air conditioning. This is a fast-paced work environment in which you will be operating office equipment including personal computers, copiers, and fax machines.

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

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

Base Salary: $90,000 - $110,000