NSA Administrative Claims Coordinator

The Phia Group is a service-oriented consulting firm that assists health plans nationwide. We provide our clients with innovative cost-containment solutions and service offerings. As employers seek to identify reasonable healthcare prices while protecting their employees from abusive billing practices, they increasingly encounter challenges from multiple directions. One area of concern is the No Surprises Act (NSA), which protects patients from balance billing but may expose health plans to significant financial risk through the federal independent dispute resolution (IDR) process.

The NSA Administrative Claims Coordinator is responsible for providing administrative and operational support to the Provider Relations: Negotiations team. This position plays a critical role in ensuring the efficient management of NSA claim disputes and related processes by preparing case files, processing payment determinations and settlement agreements, maintaining client payment information, generating invoices, and supporting the accurate closure of cases. This role requires a detail-oriented professional who is highly organized, proactive, dependable, and capable of managing multiple priorities in a fast-paced environment.

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.

Essential Duties and Responsibilities

The essential duties and responsibilities include the following. Other duties may be assigned.

• Prepare and organize claim files for negotiators, ensuring all required documentation is complete and accurate.
• Process final payment determinations issued through the federal independent dispute resolution (IDR) process and ensure appropriate follow-up actions are completed.
• Review and process signed settlement agreements and coordinate related administrative tasks.
• Create repricing sheets and generate client invoices based in accordance with client-specific requirements and company procedures.
• Accurately enter claim, payment, and settlement information within internal operating system and close completed case files.
• Maintain and regularly update a database of client-specific contact information, settlement authority, and payment-processing information.
• Participate in ongoing process improvement initiatives designed to increase efficiency and enhance the claim settlement process.
• Ensure the proper handling of confidential information in accordance with the Health Insurance Portability and Accountability Act (HIPAA) and all applicable company policies.

Experience and Qualifications

• Preferred: Bachelor's degree from an accredited college or university.
• Preferred: Experience in a medical healthcare claims role or experience at an insurance company, TPA, or hospital, preferably with emphasis in claims, fee schedules, or contracting.
• Proficiency in Microsoft Office applications, including Outlook, Word, Excel, and PowerPoint.
• Strong organizational, analytical, written communication, and interpersonal skills.

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 computers, 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.

Salary: $50,000 - $55,000 / year