Medical Claims Associate Jobs in Virginia (NOW HIRING)

Business Title(s):Workers' Compensation Claims Adjuster

Employment Type:Regular

FLSA Status:Exemptor Non-Exempt

Location:In-Office

Summary:

We are looking for a highly capable Workers' Compensation Claims Adjuster to join our Claims team and work from either our Rockwood, PA or Omaha, NE offices. Alternatively, we can also fill this role in our offices in Richmond, VA or Springfield, MO.However,we are open to considering hiring a less qualified candidate (a Trainee or Associate Adjuster) and providingadditionalon-the-job training to bring the candidate's skill set up to an Adjuster level in the next couple of years. The position reports to a manager based in Texas and is focused on adjudicating workers' compensation indemnity and medical-only claims for our largest mining account, underwritten by Rockwood Casualty, mostly in the jurisdictions of IL, IN, KY, NY, PA, and VA. Approximately 20% of the claims assigned to this position are covered by the federal black lung program. Our Adjusters contribute to providing superb results for our clients.

Although Rockwood underwrites general liability insurance and workers' compensation for many types of businesses, ourspecialtyis underwriting workers' compensation insurance for the mining industry, with a focus on the coal-mining industry. Rockwood has become a leading underwriter of workers' compensation for the mining industry by offering workers' compensation insurance with a commitment to providing the best service on loss control and claims, collaborating across all departments with this common goal. We have never been more committed to our clients to ensure their employees receive excellent medical care if they need it due to a work-related injury or illness. Our passion for outstanding customer focus, combined with our deep industry experience, is what sets up apart from other insurance carriers in this niche market.

This is a 100%in-office position. Candidates must be able to work on-site at a designated company office during standard business hours.

Essential Responsibilities:

• Working under technical direction and within significant limits and authority,adjudicateindemnity and federal black lung workers' compensation claims of higher technical complexity with a direct impact on departmental results. The amount of direction,limitsand authority will initially vary depending on the skill set of the person hired into this role. In addition,adjudicatemedical-only claims reported by the account as well.

• Providing laser-focused customer service to our clients by providing superior claims outcomes and developing meaningful andlong lastingconnections with ourinsured andbrokers.

• Resolving issues that are generalized and typically notcomplex, butrequire understanding of a broader set of issues.

• Reporting toclaims management, losscontroland underwriters on claims trends and developments.

• Identifyingloss drivers and claims trends to reduce claims frequency and severity through data analysis and improved claim management.

• Investigating claims promptly and thoroughly

• Analyzing claims forms, policies and endorsements, client instructions, and other records todeterminewhether the loss falls within the policy coverage.

• Investigating claims promptly and thoroughly, including interviewing all involved parties.

• Managing claims in litigation

• Managing diarytimelyand complete tasks to ensure that cases move to the best financial outcome andtimelyresolution.

• Creating and reviewing reserves in line with market and Argo's reserving policy

• Identifying, assigning, and coordinating the assignment and coordination ofexpertiseresources toassistin case resolution.

• Preparing reports for file documentation

• Applying creative solutions which result in the best financial outcome.

• Settles straightforward claims in line with authority limits and adheres to organizational referral procedures

• Negotiates ina timelyand effective manner to provide cost effective solutions for the company and its customers withinownlimits using a range of negotiation styles.

• Processing mail and prioritizing workload.

• Completing telephone calls and written correspondence to/from various parties (insured, claimant, etc.).

• Having an appreciation and passion for strong claim management.

Qualifications / Experience Required:

• Practical knowledge of workers' compensation claims, as well as an exceptional customer service focus typically obtained through:

• Bachelor'sdegree from an accredited universityrequired. Trainee candidates can substitute four years of general work experience for a degree. For Associate Adjuster or Adjuster candidates, two or more insurance designations or fouradditionalyears of related experienceadjudicatingworkers' compensation claims beyond the minimum experiencerequiredbelow may be substituted in lieu of a degree.

• A minimum of two years' experienceadjudicatingindemnity workers' compensation claims isrequiredfor Adjuster-level candidates. For Associate Adjuster level candidates, oneyearexperienceadjudicatingindemnity workers' compensation claims isrequired. No work experience isrequiredfor Trainee level candidates (unless substituting general work experience foradegreeas noted above). Working knowledge of the IL, IN, KY, NY, PA, and VAjurisdictionsis notrequired, but considered a considerableplus).

• Must be licensed in KY and NY or haveabilityto obtain a license toadjudicatefirst party claims in those states within90 daysof being hired.

• 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).

• Adjuster and Associate Adjuster candidates mustexhibitthe ability to regularly exercise discretion and independent judgment with respect to matters of significance.Trainee level candidates will be paid hourly and are not expected to have the skills or knowledge to exercise discretion or independent judgment due to their limited claims experience. This role primarily faces problems and issues thatgeneralizedand typically notcomplex, butrequirean understanding of a broader set of issues.

• A strong focus on execution in getting things done right. Proven ability to consistently produce and deliver expected results to all stakeholders by:

• Findinga way to achieve success through adversity.

• Being solution (not problem) focused

• Thinking with a global mindset first.

• Client focus - the ability to effectivelydeterminespecific client needs and to provide value added solutions.

• Successful traits (flexibility, ability to thrive in change, being resourceful on your own)necessaryto work in afast pacedenvironment that is evolving constantly.

• Ability to develop andmaintainproductive relationships with clients, businesspartnersand organizational peers with a focus ontimelyand meaningful exchanges of information.

• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.

• Exhibitnatural and intellectual curiosityin order toconsistently explore and consider all options and is not governed by conventional thinking.

• Excellent evaluation and strategic skillsrequired.

• Strong claim negotiation skillsa must. Ability to takeproactiveand pragmatic approach to negotiation. Negotiation skills will be taught to Trainee level candidates. Associate Adjuster candidates are expected to have a working understanding of negotiation skills that will be further honed withadditionaltraining.

• Demonstratesan understanding of mechanisms available for resolvingclaimssettlement disputes (e.g.arbitration and mediation) and when these are used.

• Adjuster level candidates should have the ability to articulate the financial value of your work at multiple responsibility levels inside our clients'businesswhich may include CEO.

• Demonstratesinner strength. Has the courage to do the right thing anddemonstratesit on a daily basis.

• Proficient in MS Office Suite and other business-related software.

• Uses listening and questioning techniques to effectively gather information from insureds and claimants

• Polished and professional written and verbal communication skills. Presents information clearly, concisely, and accurately.

• The ability to read and write English fluently isrequired.

• Mustdemonstratea desire for continued professional development through continuing education and self-development opportunities.

About Working in Claims at ArgoGroup

Wehave a very flat organizational structure, enabling our employeeshavemore interaction with our senior management team, especially when it relates to reviewing large losses.