Senior Program Claims Compliance Specialist

Argo Group International Holdings Ltd. • Chicago, IL

33d • $65,900 - $83,900 • Onsite

About The Position

We are looking for a highly capable Program Claims Compliance Specialist to join our team and work from any of our US offices in Chicago, Los Angeles, New York City, Omaha, Richmond (VA), Rockwood (PA), or San Antonio. This individual will provide a wide range of administrative support to our Programs Department. The role will work onsite (5 days per week) at one of our office locations: Los Angeles, CA, Omaha, NE, San Antonio, TX, Chicago, IL, New York City, NY, or Richmond, VA.

Requirements

• 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).
• An advanced knowledge of TPAs adjudicating claims for US programs through:
• A minimum of six years in the insurance industry, preferably in a commercial claims department, or equivalent business environment is required, that includes:
• Some experience with assisting or conducting audits with a proven ability to communicate and present findings accordingly.
• Must have excellent communication skills and the ability to build lasting relationships.
• Exhibit natural curiosity
• Desire to work in a fast-paced environment.
• 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.
• A strong focus on execution in getting things done right.
• Finding a way to achieve success through adversity.
• Being solution (not problem) focused
• Thinking with a global mindset first.
• Client focus - the ability to effectively determine specific client needs and to provide value added solutions.
• Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in a fast paced environment that is evolving constantly.
• Ability to develop and maintain productive relationships with clients, business partners and organizational peers with a focus on timely and meaningful exchanges of information.
• Polished and professional written and verbal communication skills.
• Proficient in MS Office Suite and other business-related software.
• 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.

Nice To Haves

• Familiarity with EDI and ISO is preferred.
• Assist with EDI Processing, reporting, and resolution (preferred)
• Bachelor's degree from an accredited university or industry designations are preferred but not required.

Responsibilities

• Assist our Program claims department with TPA compliance, program management and special projects with an impact on departmental results.
• Partner in production of multiple reports for state compliance, TPA reporting and summary reporting.
• Perform TPA payment audits and provide audit assistance to TPA's request for documents and communications
• Liaison for DTS on data feed maintenance
• Schedule claim reviews, collect claim summaries and distribute
• Complete annual imprest reviews while evaluating imprest levels for appropriateness
• Partner with Claim Support in finding policy information/program TPA's with limited insured information
• Assist with audit reports and tracking
• Manage TPA due diligence process and response rate though payment and compliance audits, TPA questionnaires, E&O Policy review and state licensing reviews.
• Responsible for SharePoint site updating and IT onboarding for Claims adjuster access.
• Support new Program/TPA implementations
• Manage Cash calls and process, Replenishments, Claim Fees and escrow.
• Provision new TPA's and review existing access for Argo systems
• Maintain internal program and TPA adjuster directories and service instructions
• Provide support to MGA issue resolution
• Assist with EDI Processing, reporting, and resolution (preferred)

Benefits

• 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.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Industry: Insurance Carriers and Related Activities
• Number of Employees: 11-50 employees