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Medical Only Workers' Compensation Claims Adjuster

Medical Only Workers' Compensation Claims Adjuster

Argonaut Management Services, IncLos Angeles, CA, United States
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Argo Group International Holdings, Inc . and American National, US based specialty P&C companies, (together known as BP&C, Inc.) are wholly owned subsidiaries of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. 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.

Job Description

Argo Group is a leader in specialty insurance with a vibrant culture built on respect, equality, wellness and opportunity. We're an innovative organization that's small enough to be agile and big enough to make a difference in our industry. Our 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 you're wired to raise your hand and ask, "Where can I help?", you'll thrive with us. At Argo Group, you can make a direct impact while working in an organization small enough to be agile and big enough to make a difference. We ask you to bring a growth mindset and a desire to share your unique perspective with our dynamic teams.

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 :

  • A working knowledge of medical only claims typically achieved through :

    • Six years' experience adjudicating medical only claims or related billing, customer service, or general insurance / medical experience. 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.

  • High School diploma or GED. Bachelor's degreefrom an accredited university or industry designations are preferred but not required.
  • 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 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.

    Los Angeles and New York City Pay Range :

    $34.57 - $40.34 per hour

    Albany and Chicago Pay Range :

    $31.68 - $36.97 per hour

    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.

    • PLEASE NOTE :

    Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.

    If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at 210-321-8400.

    Notice to Recruitment Agencies :

    Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and / or its affiliates will not be responsible for any fees associated with unsolicited submissions.

    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

    Benefits and Compensation

    We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.

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    Claim Adjuster • Los Angeles, CA, United States