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Medical Claims Adjuster
2 months ago
Argo Group is seeking a highly skilled Medical Claims Adjuster to join our team. As a Medical Claims Adjuster, you will be responsible for determining whether coverage exists for insureds, denying claims ineligible for benefits, and thoroughly investigating claims by interviewing injured workers, employers, and medical providers.
Key Responsibilities- Claims Investigation: Conduct thorough investigations of medical claims, including interviewing injured workers, employers, and medical providers to determine compensability issues and subrogation potential.
- Claims Denial: Deny claims that are not covered or do not meet compensability criteria and successfully defend that decision if challenged.
- Claim Management: Actively manage medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis.
- Diary Management: Manage a diary and complete tasks to ensure that cases are resolved timely and at the right financial outcome.
- Reserve Setting: Properly set claim reserves.
- Expertise Coordination: Identify and direct the assignment and coordination of expertise resources to assist in case resolution.
- Reporting: Prepare reports for file documentation.
- Workload Management: Process mail and prioritize workload.
- Customer Communication: Responsible for telephone calls from various parties (insured, claimant, etc.).
- Education: Bachelor's degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating medical only claims beyond the minimum experience required above may be substituted in lieu of a degree.
- Experience: A working knowledge of medical only claims typically achieved through: Less than two years' experience adjudicating medical only claims.
- Industry Knowledge: 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.
- Business Acumen: 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).
- Communication Skills: Must have excellent communication skills and the ability to build lasting relationships.
- Critical Thinking: Exhibit natural and intellectual curiosity in order to consistently explore and consider all options and is not governed by conventional thinking.
- Time Management: Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
- Customer Focus: Must possess a strong customer focus.
- Language Skills: 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.
- Licenses and Certifications: 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
- Total Rewards Package: A culture that recognizes performance and empowers employees to excel, offering competitive compensation and merit driven profit sharing.
- Flexible Workplace: Flexible workplace policies that support employee well-being include compressed hours, flex-time, job-sharing, remote work, sabbatical leave, and holiday hours.
- Comprehensive Benefits: Comprehensive health, wellness, and financial planning options that employees can tailor to meet their personal and family needs.
- Professional Development: Argo Academy, a digital and instructor-led platform that offers continuous learning and professional development.
- Inclusive Culture: 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.
- Community Outreach: Active community outreach and volunteer programs.
