Workers' Compensation Claims Adjuster

3 weeks ago

Richmond, Virginia, United States Argo Group Full time

At Argo Group, we're seeking a highly skilled Workers' Compensation Claims Adjuster to join our team. As a key member of our claims team, you'll be responsible for adjudicating indemnity workers' compensation claims of complexity for our customers in various states.

This role will work hybrid (no less than three days per week on-site) at one of our US offices, including Rockwood, PA, San Antonio, TX, Richmond, VA, or Chicago, IL. We're open to well-qualified candidates at the trainee level, as well as the Sr. Claims Adjuster level.

Responsibilities:

  • Analyze claim forms, policies, and endorsements to determine policy coverage.
  • Investigate claims by calling claimants, insured employers, healthcare providers, and witnesses to determine compensability issues and status of claims.
  • Deny claims that are not covered or do not meet compensability criteria and successfully defend decisions if challenged.
  • Actively manage medical-only claims to ensure only medical bills appropriate to the claim are paid on a timely basis.
  • Manage a diary, complete tasks, and apply creative solutions to ensure cases are resolved timely and at the right financial outcome.
  • Properly set claim reserves.
  • Identify and direct the assignment and coordination of expertise resources to assist in case resolution.
  • Negotiate settlements.
  • Prepare reports for file documentation.
  • Process mail and prioritize workload.
  • Handle telephone calls from various parties, including insureds, claimants, medical facilities, etc.

Qualifications:

  • Good business acumen, including understanding how an insurance company works and makes money.
  • A knowledge of adjudicating workers' compensation claims.
  • Bachelor's degree from an accredited university preferred.
  • Varying years of experience based on the level of the role.
  • Ability to prioritize workload and handle multiple tasks.
  • Ability to articulate the financial value of your work at multiple responsibility levels inside our clients' business.
  • Exhibit a natural curiosity.
  • 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.
  • Must work independently and demonstrate the ability to exercise sound judgment.
  • Proficient in MS Office Suite and other business-related software.
  • Polished and professional written and verbal communication skills.
  • Ability to travel, sometimes overnight, approximately 10% of the time.
  • The ability to read and write English fluently is required. The ability to read and write Spanish fluently is strongly preferred but not required.
  • Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.

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