Workers' Compensation Claims Adjuster

4 weeks ago


Richmond, California, United States Argo Group Full time
Job Overview

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 flexible workplace is continuously evolving to ensure all employees feel comfortable bringing their whole selves to work, confident that they will be treated respectfully, and 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.

Key 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, status of claims, and subrogation potential.
  • Deny claims that are not covered or do not meet compensability criteria and successfully defend that decision 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.

Requirements:

  • Good business acumen, including understanding how an insurance company works and makes money.
  • A knowledge of adjudicating workers' compensation claims.
  • 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.
  • Strong claim negotiation skills.
  • 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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