TEMP-Senior Medical Pricing Specialist

Argo Group is an underwriter of specialty insurance products in the property and casualty market, offering a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses.

About the role

We are looking for a highly capable Senior Medical Pricing Specialist to help us on a temporary assignment with an estimated end date. This role can be performed in-office or remotely from anywhere in the United States. The Senior Medical Pricing Specialist oversees and coordinates the accurate processing of medical payments for Workers’ Compensation (WC) claims in accordance with applicable state fee schedules, ensuring payment accuracy, vendor compliance, and efficient bill review processes while serving as a key resource for claim staff and internal stakeholders.

As this is a temporary assignment, only government-mandated benefits will be provided. Contractors are required to accurately record all hours worked and submit timesheets in accordance with company policy. Overtime may be assigned as business needs dictate.

Responsibilities

• Oversee, manage, and coordinate the end-to-end processing of medical payments for WC claims in compliance with state fee schedules and regulatory requirements.
• Audit and monitor bill review vendors to ensure accuracy, compliance, and adherence to contractual standards.
• Collaborate with Claims staff to optimize medical bill processing workflows and resolve discrepancies.
• Evaluate and reconcile daily EDI transactions for both individual and bulk medical bill payments.
• Review daily reports and Explanation of Review (EOR) documentation to verify accuracy, including Federal Tax IDs, duplicate payments, and potential errors.
• Investigate and resolve billing discrepancies, duplicate charges, and payment inconsistencies.
• Maintain accurate data entry and reporting within systems such as Web-TDS.
• Respond to medical bill inquiries and provide timely, accurate guidance to internal and external stakeholders.
• Submit reconsideration requests electronically to bill review vendors as needed.
• Support continuous process improvement efforts to enhance efficiency and payment accuracy.
• Perform additional duties as assigned.

Requirements

• A minimum of 2 years of experience in medical billing, medical pricing, or Workers’ Compensation claims processing.
• Bachelor’s degree from an accredited university required, or four additional years of related experience beyond the minimum experience required above.
• Practical knowledge of medical terms, procedures, and management, as well as the litigation process.
• Good business acumen, including an understanding of how an insurance company operates and makes money, and how this role impacts both Argo Group and our customers’ profitability.
• Excellent communication skills and the ability to build lasting relationships.
• Strong focus on execution, consistently producing and delivering expected results to all stakeholders by being solution-focused and thinking with a global mindset.
• Ability to thrive in a fast-paced, evolving environment, demonstrating flexibility, resourcefulness, and the ability to work independently.
• Excellent evaluation and strategic skills, with a strong customer focus.
• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
• Sound judgment and the courage to do the right thing daily.
• Intellectual curiosity to explore all options and challenge conventional thinking.
• Proficiency in MS Office Suite and other business-related software.
• Polished and professional written and verbal communication skills in English.
• Desire for continued professional development through continuing education and self-development opportunities.

Pay

• Colorado (outside of Denver metro), Delaware, Illinois (outside of Chicago metro), Maine, Maryland, Massachusetts (outside of Boston metro), Minnesota, Nevada, Rhode Island, Vermont, and Virginia: $37.66 per hour - $44.33 per hour.
• Boston metro area, California (outside of Los Angeles & San Francisco metro), Connecticut, Chicago metro area, Denver metro area, New Jersey (outside of New York City metro), New York State (outside of New York City metro), Washington, D.C. metro area, & Washington State: $41.44 per hour - $48.79 per hour.
• New York City, Los Angeles, and San Francisco metro areas: $45.16 per hour - $53.16 per hour.

In addition to base salary, this position is eligible for an annual bonus based on company and individual performance.

About Working in Claims at Argo Group

Argo Group values its claims professionals and offers challenging, diverse, and impactful work. Adjusters and Managers are empowered to exercise independent discretion and creativity within broad limits to develop unique solutions for each case. Our flat organizational structure fosters interaction with senior management, particularly for large losses. The claims team collaborates to resolve claims efficiently, inspiring innovation and welcoming employee suggestions. We reward creative and innovative ideas and are committed to building an inclusive and diverse team, encouraging talented individuals from all backgrounds to apply.