Medical Only Claims Adjuster

Company 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): Medical Only Claims Adjuster Employment Type: Full‑Time FLSA Status: Non‑Exempt Location: In‑Office Summary We are looking for a highly capable Medical Only Claims Adjuster to join our Claims team and work from either our Rockwood, PA, Richmond, VA, or Omaha, NE offices. Alternatively, we can also fill this role in our Springfield, MO office. The position reports to a manager based in Rockwood, PA. The Medical Only Claims Adjuster is responsible for managing medical‑only claims for non‑partnership accounts, primarily within the jurisdictions of Pennsylvania and Maryland. 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. Under close supervision, 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. Rockwood underwrites general liability insurance and workers’ compensation for many types of businesses, with a specialty in the mining industry, especially coal‑mining. 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. Employees 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. This is a 100% in‑office position. Candidates must be able to work on‑site at a designated company office during standard business hours. Essential Responsibilities Conduct 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 for non‑partnership accounts, including Federal and State Black Lung claims already reviewed with a schedule of benefits approved by the Department of Labor. Complete required alive‑and‑well checks for Black Lung claims and monitor biweekly or monthly benefit payments. Resolve issues that are generalized and typically not immediately evident, but typically not complex and within immediate job area. Deny any claims that are not covered or do not meet compensability criteria and successfully defend that decision if challenged. Actively manage medical only claims to ensure only medical billing appropriate to the claim are paid on a timely basis. Manage a diary and complete tasks to ensure that cases are resolved timely and at the right financial outcome. Properly set claim reserves. Identify and direct the assignment and coordination of expertise resources to assist in case resolution. Prepare reports for file documentation. Process mail and prioritize workload. Be responsible for telephone calls from various parties (insured, claimant, etc.). Have an appreciation and passion for strong claim management. Qualifications / Experience Required Advanced knowledge of medical only workers’ compensation claims, typically achieved through at least six years of experience adjudicating medical only claims or in the insurance or healthcare industry (preferably in a commercial claim department); familiarity with medical terminology is required. High school diploma. Good business acumen (understand how an insurance company works and makes money, including how this role impacts both Argo Group and our customers’ ability to be profitable). Strong focus on execution: consistently produce and deliver expected results to all stakeholders, find ways to achieve success through adversity, and remain solution‑focused. Excellent communication skills and ability to build lasting relationships. Curiosity, willingness to explore options, and non‑conventional thinking. Desire to work in a fast‑paced environment. Excellent evaluation and strategic skills required. Strong customer focus. Effective time management and ability to prioritize workload while handling multiple tasks and deadlines. Tenacious ability to investigate claims by interviewing involved parties and researching coverage issues and potential subrogation opportunities. Fluent English reading, speaking, and writing; polished and professional telephone communication skills. Use listening and questioning techniques to gather information from insureds and claimants. Polished and professional written and verbal communication skills; present information clearly, concisely, and accurately. Ability to network, build and maintain relationships, and establish appropriate visibility with business partners. Demonstrates inner strength and the courage to do the right thing on a daily basis. Proficient in MS Office Suite and other business‑related software. Desire for continued professional development through continuing education and self‑development opportunities. Licensed Claims Examiner (Based on state) or ability to quickly obtain a license in each jurisdiction required to adjudicate first‑party claims within 120 days. Preferred Qualifications Fluency in Spanish (preferred). Familiarity with the MD and PA jurisdictions (strongly preferred). 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 employees to have more interaction with senior management, 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. Notice To Recruitment Agencies Resumes submitted for this or any other position without prior authorization from Human Resources will be considered unsolicited. BWS and/or its affiliates will not be responsible for any fees associated with unsolicited submissions. Equal Opportunity Employer We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical) , including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, child birth, breastfeeding, and medical conditions related to pregnancy, child birth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics. The collection of your personal information is subject to our HR Privacy Notice. 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. #J-18808-Ljbffr Argo Group