Medical Only Claims Adjuster
Medical Only Claims Adjuster
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Job Description
Argo Group is a leader in specialty insurance with a vibrant culture built on respect equality wellness and opportunity. Were an innovative organization thats small enough to be agile and big enough to make a difference in our industry.
Our collaborative workplace is continuously evolving to ensure all employees feel:
- Comfortable bringing their whole selves to work.
- Confident that they will be treated respectfully.
- Recognized for their performance and provided with equal opportunities to succeed.
At Argo skill meets opportunity. If youre wired to raise your hand and ask Where can I help youll thrive with us.
Argo Group a global multiline underwriter of specialty insurance and reinsurance products in the property and casualty market offers a comprehensive line of high-quality products and services designed to meet the unique coverage and claims-handling needs of our clients. We foster an inclusive culture that embraces diversity and design thinking relies on innovation and agility promotes collaborative service delivery frequent integrated communication and authentic recognition of excellence. We work together in the office five days a week in order to strengthen our culture build team connections and drive profitability.
A Brief Overview
We are looking for a highly capable Medical Only Claims Adjuster to join our team and work in one of our US offices. We work together in the office five days a week in order to strengthen our culture build team connections and drive profitability. The medical only claims adjuster responsibilities include determining whether coverage exists in our system for the insured denying claims ineligible for benefits and thoroughly investigating the claim by interviewing the injured worker employer and medical provider.
How You Will Make an Impact:
- Under close supervision and guidance works within narrowly defined limits with an impact on departmental results - this requires calling the claimant insured employer healthcare provider and witnesses to determine compensability issues and subrogation potential.
- Resolving issues that are generalized and typically not immediately evident but typically not complex and within immediate job area.
- Denying any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged.
- Actively manage medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis.
- Managing a diary and completing tasks to ensure that cases are resolved timely and at the right financial outcome.
- Properly setting claim reserves.
- Identifying and directing the assignment and coordination of expertise resources to assist in case resolution.
- Preparing reports for file documentation
- Processing mail and prioritizing workload.
- Responsible for telephone calls from various parties (insured claimant etc.).
- Having an appreciation and passion for strong claim management.
What We Need:
- Bachelors degreefrom an accredited university or industry designations are preferred but not required. Two or more insurance designations or six additional years of related industry experience beyond the minimum experience required above may be substituted in lieu of a degree.
- A working knowledge of medical only claims typically achieved through: Less than two years experience adjudicating medical only claims.
- At least one year of experience in the insurance or healthcare industry (preferably in a commercial claim department) is required as is familiarity with medical terminology.
- Must have good business acumen (i.e. understand how an insurance company works and makes money including how this role impacts both Argo Group and our customers ability to be profitable).
- Must work independently and demonstrate the ability to exercise sound judgment with respect to matters of significance. This role faces issues that are moderately complex and not immediately evident.
- Must have excellent communication skills and the ability to build lasting relationships.
- Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
- Desire to work in a fast-paced environment.
- Excellent evaluation and strategic skills required.
- Strong claim negotiation skills a must.
- Must possess a strong customer focus.
- Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
- Must be tenacious in ability to investigate claims by interviewing injured worker employer witnesses and healthcare providers and researching coverage issues and potential subrogation opportunities.
- The ability to read speak and write English fluently is required. Polished and professional telephone communication skills are essential. The ability to read and write Spanish fluently is not required but is preferred.
- Must demonstrate the ability to exercise sound judgment working under moderate supervision.
- Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis.
- Proficient in MS Office Suite and other business-related software.
- Polished and professional written and verbal communication skills.
- The ability to read and write English fluently is required.
- Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.
- Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims within 120 Days
The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location. In addition to base salary all employees are eligible for an annual bonus based on company and individual performance as well as a generous benefits package.
New York City metro area Pay Range:
$71800 - $83600
Chicago metro area Pay Range:
$65800 - $76700
Physical Demands
Unless otherwise specified below as an essential function of the job this role generally operates within a standard office environment (on-site remote or hybrid); requiring the use of a PC and other related office equipment.
About Working in Claims at Argo Group
- Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging diverse and impactful.
- Our Adjusters and Managers are empowered to exercise their independent discretion and within broad limits and authority be creative in developing solutions and treat each case as the unique situation it is.
- We have a very flat organizational structure enabling our employees have more interaction with our senior management team especially when it relates to reviewing large losses.
- Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.
- We believe in building an inclusive and diverse team and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.
How We Work - Our Employee Values
Employees at Argothrive togetheras a responsible profitable specialty insurer where all stakeholders share in our success.
We are committed to:
- Demonstrate entrepreneurial spirit:
- Get the job done in a non-bureaucratic resourceful manner.
- Create a culture of accountability ensuring the delivery of world-class products and services.
- Do the right thing:
- Act with integrity always.
- Adhere to the commitments set forth in the Argo Group Environmental Social and Governance program.
- Collaborate:
- Create an open and transparent environment in which diverse experience skill sets and individuals can team together to drive optimal outcomes.
- Encourage and include unique perspectives at all times.
- Respect each other:
- Create an environment that promotes dialogue mutual support and cooperation between and among all where people are fun to be around proud of what they do and willing to achieve beyond normal expectations.
PLEASE NOTE: At this time Argo Group will not sponsor an applicant for employment authorization for this position.
If you have a disability under the Americans with Disabilities Act or a similar law and you wish to discuss potential accommodations related to applying for employment at Argo Group please contact our Benefits Department at .
To all recruitment agencies: Unless you have been requested to work on this position or other positions with Argo Group please do not forward any resumes to Argo Group employees. Argo Group is not responsible for any fees related to unsolicited resumes.
Argo Group International Holdings Inc. (Argo or the Company) is a wholly owned subsidiary of Brookfield Wealth Solutions Ltd. (BWS) a New York and Toronto-listed public company. Argo with over $8 billion of assets on its balance sheet is a leading underwriter of specialty insurance products in the property and casualty (P&C) market working with independent agents wholesale brokers and retail brokerage partners to deliver collaborative solutions for niche markets.
BWS is a leading wealth solutions provider focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services and tailored capital solutions. BWS is backed by Brookfield Corporation a leading global investment firm whose asset management business manages more than $1 trillion in assets as of September 30 2024.
We are an Equal Opportunity Employer. We do not discriminate on the basis of age ancestry color gender gender expression gender identity genetic information marital status national origin or citizenship (including language use restrictions) denial of family and medical care leave disability (mental and physical) including HIV and AIDS medical condition (including cancer and genetic characteristics) race religious creed (including religious dress and grooming practices) sex (including pregnancy child birth breastfeeding and medical conditions related to pregnancy child birth or breastfeeding) sexual orientation military or veteran status or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.
The collection of your personal information is subject to our HR Privacy Notice
Our Benefits
Developing our employees professionally and personally strengthens our organization.
Argo Group offers an attractive Total Rewards package that includes:
- A culture that recognizes performance and empowers employees to excel offering competitive compensation and merit driven profit sharing.
- Workplace policies that support employee well-being include flex time and floating holidays.
- Comprehensive health wellness and financial planning options that employees can tailor to meet their personal and family needs. In addition to traditional health and wellness plans benefits include dental disability life insurance medical and vision insurance matching 401(k) retirement savings generous paid time off (21 days of PTO 11 paid company holidays 3 floating holidays and a paid voluntary day) paid caregiver and parental leave paid bereavement jury duty/court appearances and military (up to 14 days) leave employee assistance program (EAP) and an array of voluntary benefits.
- Argo Academy a digital and instructor-led platform that offers continuous learning and professional development Trainingmagazine lists Argo among the Training Top 125 Companies. Argo encourages career mobility and continuing education to pursue and maintain professional and industry designations in addition to traditional university and higher education programs.
- An inclusive culture that develops and sponsors diverse teams encourages cross-functional engagement and collaboration builds community through employee resource groups (ERGs) and provides an environment that welcomes ongoing dialogue creative innovation professional and personal development.
- Active community outreach and volunteer programs.
- A generous Employee Referral program that results in approximately 25% of all new hires annually.
Employment Type
Full Time
