TEMP-Workers' Compensation Claims Adjuster

BP&C•Albany, NY

11d•Remote

About The Position

Argo Group is seeking a capable Workers' Compensation Claims Adjuster to join their team, with the flexibility to work remotely from anywhere in the United States. This role reports to a manager in Rockwood, PA, and will initially focus on adjudicating medical-only and indemnity claims within South Carolina. The position also involves managing Federal and State Black Lung claims that have already been reviewed and approved by the Department of Labor. Key responsibilities include investigating compensability, conducting outreach to claimants, employers, and providers (including alive-and-well checks), setting reserves, denying non-compensable claims, and ensuring timely and accurate medical payments. The role emphasizes strong claim management fundamentals, prompt resolution, thorough documentation, and consistent communication with all stakeholders. Argo Group specializes in workers' compensation insurance for the mining industry, particularly coal mining, and is committed to providing excellent service in loss control and claims.

Requirements

A practical knowledge of adjudicating workers' compensation claims.
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.
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).
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.
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.

Responsibilities

Adjudicate workers' compensation claims of higher technical complexity under technical direction and within significant limits and authority.
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.
Complete required alive-and-well checks for Black Lung claims and monitor biweekly or monthly benefit payments.
Resolve issues that are generalized and typically not immediately evident, but typically not complex and within the immediate job area.
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 medical bills appropriate to the claim 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.
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.).