TEMP-Workers' Compensation Claims Adjuster

About the role

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.

Responsibilities

• Adjudicate workers' compensation claims of higher technical complexity, with a direct impact on departmental results.
  • 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, 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 managing 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.

Pay

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: $37.66 - $44.33
• New York City, Los Angeles and San Francisco metro areas: $45.12 - $53.16
• 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: $41.44 - $48.79

Schedule

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.

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.