TEMP-Workers' Compensation Claims Adjuster

Company
Argo Group

Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Job Description

Business Title(s): TEMP - Workers' Compensation Claims Adjuster

Employment Type: Contingent Worker

FLSA Status: Non-Exempt

Location: In-Office or Remote

Summary:
We are looking for a highly capable Workers' Compensation Claims Adjuster to join our team and work from anywhere in the United States. The position reports to a manager based in Rockwood, PA and initially will be focused on adjudicating medical-only claims and indemnity claims, in the jurisdiction of SC. In addition, this position manages both Federal and State Black Lung claims that have already been reviewed and a schedule of benefits approved by the Department of Labor. This role investigates compensability, conducts claimant, employer, and provider outreach (including required alive-and-well checks), sets reserves, denies non-compensable claims, and ensures appropriate medical payments are made timely and accurately. The position emphasizes strong claim management fundamentals, timely resolution, thorough documentation, and consistent communication with all claim stakeholders. Our Adjusters contribute to providing superb results for our clients.


Although Rockwood underwrites general liability insurance and workers' compensation for many types of businesses, our specialty is underwriting workers' compensation insurance for the mining industry, with a focus on the coal-mining industry. Rockwood has become a leading underwriter of workers' compensation for the mining industry by offering workers' compensation insurance with a commitment to providing the best service on loss control and claims, collaborating across all departments with this common goal. We have never been more committed to our clients to ensure their employees receive excellent medical care if they need it due to a work-related injury or illness. Our passion for outstanding customer focus, combined with our deep industry experience, is what sets up apart from other insurance carriers in this niche market.


As this is a temporary assignment, only government mandated benefits will be provided.

Contractors in this role are required to accurately record all hours worked and submit timesheets in accordance with company policy. Overtime may be assigned as business needs dictate, and employees are expected to work overtime when required.

Essential Responsibilities:

• Working under technical direction and within significant limits and authority, adjudicate workers' compensation claims of higher technical complexity, with a direct impact on departmental results. This requires conducting thorough claim investigations by interviewing injured workers, insured employers, medical providers, and other relevant parties to determine compensability issues and subrogation potential.
• Manage medical-only claims, including Federal and State Black Lung claims that have already been reviewed and a schedule of benefits approved by the Department of Labor.
• Completing required alive-and-well checks for Black Lung claims and monitoring of biweekly or monthly benefit payments.
• Resolving issues that are generalized and typically not immediately evident, but typically not complex and within immediate job area.
• Denying any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged.
• Actively manage medical only claims to ensure only medical bills appropriate to the claim are paid on a timely basis.
• Managing a diary and completing tasks 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.
• Preparing reports for file documentation
• Processing mail and prioritizing workload.
• Responsible for telephone calls from various parties (insured, claimant, etc.).
• Having an appreciation and passion for strong claim management

Qualifications / Experience Required:

• A practical knowledge of adjudicating workers' compensation claims through:
  • A minimum of five years' experience adjudicating workers' compensation claims in SC
  • Bachelor's degree from an accredited university required. Two or more insurance designations or four additional years of related experience adjudicating indemnity claims beyond the minimum experience required above may be substituted in lieu of a degree.
  • SC license is required at start of the assignment
• 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 have excellent communication skills and the ability to build lasting relationships.
• Exhibit 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.
• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
• Ability to articulate the financial value of your work at multiple responsibility levels inside our clients' business which may include CEO.
• Must work independently and demonstrate the ability to exercise sound judgment.
• Demonstrates inner strength. Has the courage to do the right thing and demonstrates it on a daily basis.
• Intellectual curiosity. Consistently considers all options and is not governed by conventional thinking.
• Proficient in MS Office Suite and other business-related software.
• Polished and professional written and verbal communication skills.
• The ability to read and write English fluently is required.
• Must demonstrate a desire for continued professional development through continuing education and self-development opportunities.

The base salary range provided below is for hires in those geographic areas only and will be commensurate with candidate experience. Pay ranges for candidates in other locations may differ based on the cost of labor in that location.

• Colorado outside of Denver metro, Delaware, Illinois (outside of Chicago metro area), Maine, Maryland, Massachusetts (outside of Boston metro area), Minnesota, Nevada, Rhode Island, Vermont, and Virginia Pay Ranges: $37.66 - $44.33
• Boston metro area, California outside of Los Angeles & San Francisco metro area, Connecticut, Chicago metro area, Denver metro area, New Jersey (outside of New York City metro area), New York State (outside of New York City metro area), Washington, D. C. metro area, & Washington State Pay Ranges: $41.44 - $48.79

• New York City, Los Angeles and San Francisco metro areas Pay Ranges: $45.12 - $53.16

About Working in Claims at Argo Group

• Argo Group does not treat our claims or our claims professionals as a commodity. The work we offer is challenging, diverse, and impactful.
• Our Adjusters and Managers are empowered to exercise their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is.
• We have a very flat organizational structure, enabling our employees have more interaction with our senior management team, especially when it relates to reviewing large losses.
• Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.
• We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.

PLEASE NOTE:

Applicants must be legally authorized to work in the United States. At this time, we are not able to sponsor or assume sponsorship of employment visas.

If you have a disability under the Americans with Disabilities Act or similar state or local law and you wish to discuss potential reasonable accommodations related to applying for employment with us, please contact our Benefits Department at View phone number on click.appcast.io.


Benefits and Compensation

We offer a competitive compensation package, performance-based incentives, and a comprehensive benefits program-including health, dental, vision, 401(k) with company match, paid time off, and professional development opportunities.

Core Values

At Clearbrook our Core Values are Integrity, Collaboration, Pursuit of Excellence and Forward Thinking. These values reflect who we are today and who we apsire to be - guiding how we work, how we lead and how we succeed.