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Medical Claims Specialist

2 months ago

MagstattleBas, Grand Est, United States Argo Group Full time

About Argo Group
Argo Group stands at the forefront of specialty insurance, fostering a dynamic culture grounded in respect, equality, wellness, and opportunity. As an innovative organization, we balance agility with the capacity to effect meaningful change within our industry.

Our Workplace Culture
We are committed to creating a flexible work environment that evolves continuously to ensure all employees feel:

  • Comfortable expressing their authentic selves.
  • Confident in receiving respectful treatment.
  • Recognized for their contributions and provided with equitable opportunities for advancement.

At Argo, we believe that skill and opportunity go hand in hand. If you are someone who proactively seeks ways to contribute, you will find a thriving environment here.


Position Overview
The role of the Medical Only Claims Adjuster encompasses the evaluation of coverage availability for insured parties, the denial of claims that do not qualify for benefits, and the comprehensive investigation of claims through interviews with injured workers, employers, and medical providers.

Key Responsibilities:
  • Work under close supervision to address narrowly defined tasks that influence departmental outcomes, including contacting claimants, insured employers, healthcare providers, and witnesses to assess compensability and subrogation potential.
  • Resolve generalized issues that may not be immediately apparent but are typically straightforward within the job scope.
  • Deny claims that do not meet coverage or compensability criteria, effectively defending those decisions when necessary.
  • Manage medical-only claims to ensure timely payment of appropriate medical expenses.
  • Maintain a diary and complete necessary tasks to ensure timely resolution of cases with optimal financial outcomes.
  • Set claim reserves accurately.
  • Identify and coordinate expert resources to aid in case resolution.
  • Prepare documentation reports for case files.
  • Process correspondence and prioritize workload efficiently.
  • Handle telephone communications from various stakeholders.
  • Demonstrate a strong commitment to effective claims management.

Qualifications:
  • A Bachelor’s degree from an accredited institution is required. Alternatively, two or more insurance designations or four additional years of relevant experience in adjudicating medical-only claims may substitute for a degree.
  • Familiarity with medical-only claims, typically gained through less than two years of relevant experience.
  • At least one year of experience in the insurance or healthcare sector, preferably within a commercial claims department, along with a solid understanding of medical terminology.
  • Strong business acumen, with an understanding of the insurance industry and the financial implications of this role for both Argo Group and our clients.
  • Ability to work independently and exercise sound judgment in significant matters, addressing moderately complex issues.
  • Excellent communication skills and the ability to foster lasting relationships.
  • A natural curiosity to explore all options and think beyond conventional methods.
  • A desire to thrive in a fast-paced environment.
  • Strong evaluation and strategic skills.
  • Proficient negotiation skills.
  • A customer-focused mindset.
  • Effective time management skills, with the ability to prioritize tasks while managing multiple deadlines.
  • Tenacity in investigating claims through interviews and research.
  • Fluency in English is required; proficiency in Spanish is preferred but not mandatory.
  • Demonstrated sound judgment while working under moderate supervision.
  • Exhibit integrity and the courage to uphold ethical standards consistently.
  • Proficiency in MS Office Suite and other relevant software.
  • A commitment to ongoing professional development through education and self-improvement opportunities.
  • Licensure as a Claims Examiner is required based on state regulations, with the ability to obtain necessary licenses within 120 days.

Our Employee Values
At Argo, we believe in fostering a collaborative and respectful environment where all employees can thrive. We are dedicated to:
  • Demonstrating an entrepreneurial spirit by delivering results in a resourceful manner.
  • Upholding integrity in all actions and adhering to our commitments.
  • Encouraging collaboration and inclusivity to drive optimal outcomes.
  • Creating a supportive atmosphere that promotes dialogue and mutual respect.

Physical Demands
This role generally operates within a standard office environment, requiring the use of a PC and related office equipment.