Senior Health Benefits Consulting Counsel

The Phia Group; Canton (MA); Remote; USD 140,000 - 190,000; Full time

Job summary

The Phia Group, LLC is a prominent Canton, Massachusetts-based health benefits consulting firm seeking a Sr. Health Benefit Plan Consulting Attorney.

The role focuses on solving complex health plan issues, ERISA compliance, and regulatory matters while supporting consulting, transactional, and accountability efforts with our legal team. Ideal candidates will hold a JD, bar admission, and 3–7 years in healthcare or related fields, with strong writing, analytical, and negotiation abilities.

Qualifications

• Juris Doctor from an accredited law school and licensed to practice (active) in a state.
• 3–7 years of experience in healthcare or related industries (employment, insurance, disability, workers’ compensation).
• Knowledge of ACA, ERISA, MHPAEA, and HIPAA.

Responsibilities

• 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 for regulatory compliance.
• Support internal audits, agency audits, corrective action plans, and external regulator or client requests.
• Conduct legal research on applicable law and regulations; draft consulting memoranda; provide consultative advice to the legal team.
• Review healthcare industry contracts.
• Respond to client inquiries regarding agency rules, statutory requirements, and legal compliance.
• Communicate with health plan administrators and healthcare entities; explain laws and plan terms clearly.
• Draft ERISA and ACA-compliant health plan documents, including MHPAEA reports.
• Assist in resolving disputes between healthcare industry players.
• Provide thorough analysis of health plans; summarize findings for the legal team.

Skills

Superior legal writing

Analytical skills

Negotiation skills

Interpersonal skills

Education

Juris Doctor and bar admission

Tools

Microsoft Word

Excel

Outlook

Job description

The Phia Group, LLC is a prominent Canton, Massachusetts-based health benefits consulting firm seeking a Sr. Health Benefit Plan Consulting Attorney.

The role focuses on solving complex health plan issues, ERISA compliance, and regulatory matters while supporting consulting, transactional, and accountability efforts with our legal team. Ideal candidates will hold a JD, bar admission, and 3–7 years in healthcare or related fields, with strong writing, analytical, and negotiation abilities.