What are the responsibilities and job description for the Claims Associate position at Argo Group?
A Brief Overview
We are looking for a highly capable Workers' Compensation Claims Adjuster to join our team and work from our Rockwood office or another of our US Offices. This role will adjudicate indemnity workers' compensation claims of complexity for our customers in various states.
The role will work onsite (5 days per week) at one of our following offices: Rockwood, PA, San Antonio, TX, Richmond, VA or Chicago, IL.
This is a Claims Associate role. However, well qualified candidates for a Claims Trainee, Claims Adjuster and Sr. Claims Adjuster level will also be considered.
Responsibilities:
- Under close/moderate supervision and guidance, analyzing claim forms, policies and endorsements, client instructions and other records to determine whether the loss falls within the policy coverage
- Investigating the claim - this requires calling the claimant, insured employer, healthcare provider, and witnesses to determine compensability issues, status of claims (medical only or indemnity), and subrogation potential.
- Denying any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged.
- Actively managing medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis.
- Managing a diary, completing tasks and applying creative solutions to ensure that cases are resolved timely and at the right financial outcome.
- Properly setting claim reserves.
- Identifying and directing the assignment and coordination of expertise resources to assist in case resolution.
- Negotiating settlements
- Preparing reports for file documentation
- Processing mail and prioritizing workload.
- Responsible for telephone calls from various parties (insured, claimant, medical facilities, etc.).
- Having an appreciation and passion for strong claim management.
Qualifications:
- 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).
- A knowledge of adjudicating workers' compensation claims through
- Bachelor’s degree from an accredited university preferred (but not required).
- Various 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 which may include the CEO.
- 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.
