No Surprises Act Claims Specialist

The Phia Group, LLC; Louisville (KY); On-site; USD 50,000 - 65,000; Full time

Job summary

The Phia Group, LLC in Louisville, KY, seeks a Claims Specialist to assist with No Surprises Act operations and settlement submissions for Independent Dispute Resolution. You will monitor deadlines, draft settlement agreements, and support balance billing and overpayment matters in a fast-paced environment.

The role requires proactive, persuasive, and compliant communication with facilities, providers, and internal teams, while maintaining confidentiality and strong written and verbal skills.

Qualifications

• Preferred: Baccalaureate degree (BA/BS) from an accredited college or university.
• Experience in medical healthcare claims or negotiation preferred.
• Computer literate, including Microsoft Office products.

Responsibilities

• Manage daily running inventory of unpaid claims or claim disputes.
• Review and prioritize claims based on processing criteria, timelines, client demands, and service levels.
• Contact facilities and providers to discuss charge adjustments and rationale.
• Draft correspondence pertaining to settlement and negotiation efforts for providers.
• Capture detailed notes on calls for future reference.
• Handle member inquiries in accordance with their medical plan.
• Support the legal department to escalate claims and participate in process improvements.

Education

BA/BS degree

Tools

Microsoft Office

Job description

The Phia Group, LLC in Louisville, KY, seeks a Claims Specialist to assist with No Surprises Act operations and settlement submissions for Independent Dispute Resolution. You will monitor deadlines, draft settlement agreements, and support balance billing and overpayment matters in a fast-paced environment.

The role requires proactive, persuasive, and compliant communication with facilities, providers, and internal teams, while maintaining confidentiality and strong written and verbal skills.