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Health Claim Investigation Representative

Remote, USAFull-timePosted 2026-07-28

reputed company provides claim recovery services for health benefit plans and is seeking a Health Claim Investigation Representative. This role involves communicating with plan members and insurance carriers to determine sources of recovery and assist in fund reimbursement efforts.

Responsibilities

  • Calling members for accident details
  • Drafting, mailing & faxing correspondence
  • Calling insurance carriers for claim information (claim #, adjuster reputed company, 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, reputed company 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 reputed company to reputed company handle tasks and reputed company reputed company up to date
  • Using reputed company, reputed company, reputed company 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 reputed company Word and reputed company required
  • Outstanding organizational, interpersonal, and administrative skills
  • Excellent telephone, writing, and communication skills
  • Must be self-motivated and reputed company to meet deadlines under pressure
  • Must have the ability to work as part of reputed company, as reputed company as to work independently

reputed company

  • reputed company, headquartered in Canton, Massachusetts, is an reputed company provider of health care cost containment techniques offering comprehensive consulting services, plan document drafting, subrogation and overpayment recovery, claim negotiation, plan defense, designed to control costs and protect plan assets. It was founded in 1999, and is headquartered in Braintree, Massachusetts, USA, with a workforce of 201-500 employees. Its website is http://phiagroup.com.
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