Medical Only Claims Adjuster

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. 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. Responsibilities Manage medical‑only claims for non‑partnership accounts, primarily within Pennsylvania and Maryland. Investigate compensability and conduct claimant, employer, and provider outreach (including required alive‑and‑well checks), set reserves, deny non‑compensable claims, and ensure appropriate medical payments are made timely and accurately. Handle both Federal and State Black Lung claims that have already been reviewed and have a schedule of benefits approved by the Department of Labor, completing required alive‑and‑well checks and monitoring biweekly or monthly benefit payments. Under close supervision, conduct thorough claim investigations by interviewing injured workers, insured employers, medical providers, and other relevant parties to determine compensability issues and sub‑rogation potential. Actively manage medical‑only claims to ensure only medical bills appropriate to the claim are paid in a timely basis. Maintain a diary and complete tasks to ensure 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. Handle telephone calls from various parties (insured, claimant, etc.) and coordinate communication with all claim stakeholders. Qualifications 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), including familiarity with medical terminology. Strong business acumen; understanding of how an insurance company works and makes money, including how this role impacts both Argo Group and our customers' profitability. Proven ability to consistently produce and deliver expected results to all stakeholders by finding a way to achieve success through adversity, being solution‑focused (not problem‑focused), and building lasting relationships. Excellent communication skills, both written and verbal, with the ability to build relationships and present information clearly, concisely, and accurately. Effective time‑management skills and ability to prioritize workload while handling multiple tasks and deadlines. Tenacious investigative skills, including ability to interview injured workers, employers, witnesses, healthcare providers, research coverage issues, and identify potential sub‑rogation opportunities. Fluency in reading, speaking, and writing English; polished and professional telephone and written communication skills. Proficiency 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 to adjudicate first‑party claims within 120 days. Preferred Qualifications Proficiency in reading and writing Spanish (preferred, not required). Strong familiarity with Maryland and Pennsylvania jurisdictions. 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. 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. Equal Opportunity Employer Statement 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, sex (including pregnancy, childbirth, breastfeeding, and medical conditions related to pregnancy, childbirth 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 Argonaut Management Services, Inc