Workers’ Compensation Claims Trainee

About the role

Argo Group is an underwriter of specialty insurance products in the property and casualty market. We are looking for a highly capable Workers’ Compensation Claims Adjuster Trainee to join our team and work from their home in New Mexico. The position reports to a manager based in Rockwood, PA and initially will be focused on adjudicating medical-only claims and will eventually be trained on adjudicating low complexity indemnity claims. 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

• Under close supervision, investigate compensability, 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.
• Adjudicate medical-only claims and Federal and State Black Lung claims with approved schedules of benefits.
• Complete required alive‑and‑well checks for Black Lung claims and monitor biweekly or monthly benefit payments.
• Deny claims that are not covered or do not meet compensability criteria and defend those decisions if challenged.
• Actively manage medical-only claims to ensure only appropriate medical bills are paid on a timely basis.
• Manage a diary and complete tasks to ensure cases are resolved timely and at the right financial outcome.
• Properly set claim reserves and identify resources to assist in case resolution.
• Prepare reports for file documentation, process mail, and prioritize workload.
• Respond to telephone calls from insureds, claimants, and other parties.

Requirements

• High School diploma.
• At least six years’ experience adjudicating medical only claims or in the insurance or healthcare industry (preferably in a commercial claim department).
• Familiarity with medical terminology.
• A bachelor's degree from an accredited university can substitute for 5 of the 6 years of required experience.
• Strong business acumen, including understanding how an insurance company works and makes money.
• Excellent communication skills and the ability to build lasting relationships.
• Natural and intellectual curiosity to explore and consider all options.
• Desire to work in a fast-paced environment with strong customer focus.
• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
• Tenacious ability to investigate claims by interviewing injured workers, employers, witnesses, and healthcare providers and researching coverage issues and potential subrogation opportunities.
• Fluent English reading, speaking, and writing skills; polished and professional telephone communication skills.
• Proficient in MS Office Suite and other business-related software.
• Desire for continued professional development through continuing education and self-development opportunities.
• Must be licensed or have the ability to quickly obtain a license in each jurisdiction requiring a license to adjudicate first party claims within 120 days.

Preferred Qualifications

• Ability to read and write Spanish fluently.
• Bachelor’s degree from an accredited university.

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 independent discretion and develop creative solutions, treating each case as unique. We have a flat organizational structure that fosters collaboration with senior management, especially on large losses. Our claims team works collaboratively to expeditiously resolve claims in an environment that inspires innovation and values employee suggestions. We offer rewards for creative and innovative ideas and are committed to building an inclusive and diverse team.