Claims Adjuster

7 days ago

MagstattleBas, Grand Est, United States Argo Group Full time
Job Summary

Argo Group is seeking a skilled Medical Claims Adjuster to join our team. As a Medical Claims Adjuster, you will play a critical role in 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.
  • Claim Denial: Deny claims that are not covered or do not meet compensability criteria and successfully defend that decision if challenged.
  • Case 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.).
Requirements
  • 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: 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.
  • Skills: 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.
  • 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.
What We Offer
  • 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.

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