Senior Program Claims Compliance Specialist

Argonaut Management Services, Inc; Omaha (NE); On-site; USD 60,000 - 90,000; Full time

Job summary

An innovative organization is seeking a Program Claims Compliance Specialist to join their team. This role involves providing administrative support to the Programs Department, focusing on EDI processing, reporting, and compliance. The ideal candidate will possess strong business acumen and communication skills, with a minimum of six years in the insurance industry. The collaborative workplace fosters an environment where employees are recognized for their performance and provided with opportunities to thrive. Join a company that values respect, equality, and wellness, and make a meaningful impact in the specialty insurance sector.

Benefits

Competitive Compensation

Flexible Work Policies

Comprehensive Health Insurance

401(k) Matching

Generous Paid Time Off

Professional Development Opportunities

Employee Assistance Program

Community Outreach Programs

Employee Referral Program

Qualifications

• 6+ years in the insurance industry, preferably in commercial claims.
• Excellent communication and relationship-building skills required.

Responsibilities

• Assist with TPA compliance and program management.
• Perform EDI processing, reporting, and resolution.
• Manage TPA due diligence and audit processes.

Skills

Business Acumen

Communication Skills

Problem-Solving

Data Analysis

Client Focus

Flexibility

Intellectual Curiosity

Education

Bachelor's Degree

Tools

MS Office Suite

EDI

Job description

Argo Group is a leader in specialty insurance with a vibrant culture built on respect, equality, wellness and opportunity. We're an innovative organization that's small enough to be agile and big enough to make a difference in our industry.

Our collaborative workplace is continuously evolving to ensure all employees feel:

• Comfortable bringing their whole selves to work.
• Confident that they will be treated respectfully.
• Recognized for their performance and provided with equal opportunities to succeed.

At Argo, skill meets opportunity. If you're wired to raise your hand and ask, "Where can I help?", you'll thrive with us.

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 and perform EDI processing, reporting, and resolution.

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.

The primary duties and responsibilities of the role are:

• Under close supervision and guidance, works within narrowly defined limits and authority, assist our Program claims department with TPA compliance, program management and special projects with an impact on departmental results.
• Resolving issues that are generalized and typically not immediately evident, but typically not complex and within immediate job area.
• 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.
• Responsible for making independent adjustments or recommended enhancements in ad hoc special projects utilizing related business expertise.
• Manage TPA due diligence process and response rate through 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.
• Manage combined trial calendar and set diaries for Account Managers.
• Point of contact for new law firm approval and legal fee change request process.
• Maintain internal program and TPA adjuster directories and service instructions.
• Provide support to MGA issue resolution.
• Perform EDI processing, reporting, and resolution.

Core qualifications and requirements for this position include:

• 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 is required, that includes:
• Familiarity with EDI and ISO is required.
• Experience conducting audits with a proven ability to communicate and present findings accordingly.
• Bachelor's degree from an accredited university or industry designations are preferred but not required.
• 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. Proven ability to consistently produce and deliver expected results to all stakeholders by:
• 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.

How We Work - Our Employee Values

Employees at Argo thrive together as a responsible, profitable specialty insurer where all stakeholders share in our success.

We are committed to:

• Demonstrate entrepreneurial spirit:
• Get the job done in a non-bureaucratic, resourceful manner.
• Create a culture of accountability ensuring the delivery of world-class products and services.
• Do the right thing:
• Act with integrity always.
• Adhere to the commitments set forth in the Argo Group Environmental, Social and Governance program.
• Collaborate:
• Create an open and transparent environment in which diverse experience, skill sets, and individuals can team together to drive optimal outcomes.
• Encourage and include unique perspectives at all times.
• Respect each other:
• Create an environment that promotes dialogue, mutual support and cooperation between and among all, where people are fun to be around, proud of what they do, and willing to achieve beyond normal expectations.

Physical Demands

Unless otherwise specified below as an essential function of the job, this role generally operates within a standard office environment requiring the use of a PC and other related office equipment.

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 their independent discretion and, within broad limits and authority, be creative in developing solutions and treat each case as the unique situation it is.

We have a very flat organizational structure, enabling our employees to have more interaction with our senior management team, especially when it relates to reviewing large losses.

Our entire claims team works in a collaborative nature to expeditiously resolve claims. We offer a work environment that inspires innovation and is open to employee suggestions. We even offer rewards for creative and innovative ideas.

We believe in building an inclusive and diverse team, and we strive to make our office a welcoming space for everyone. We encourage talented people from all backgrounds to apply.

PLEASE NOTE: At this time, Argo Group will not sponsor an applicant for employment authorization for this position.

If you have a disability under the Americans with Disabilities Act or a similar law and you wish to discuss potential accommodations related to applying for employment at Argo Group, please contact our Benefits Department at 210-321-8400.

To all recruitment agencies: Unless you have been requested to work on this position, or other positions with Argo Group, please do not forward any resumes to Argo Group employees. Argo Group is not responsible for any fees related to unsolicited resumes.

Argo Group International Holdings, Inc. ("Argo" or the "Company") is a wholly owned subsidiary of Brookfield Wealth Solutions, Ltd. ("BWS"), a New York and Toronto-listed public company. Argo, with over $8 billion of assets on its balance sheet, is a leading underwriter of specialty insurance products in the property and casualty (P&C) market, working with independent agents, wholesale brokers, and retail brokerage partners to deliver collaborative solutions for niche markets.

BWS is a leading wealth solutions provider, focused on securing the financial futures of individuals and institutions through a range of wealth protection and retirement services, and tailored capital solutions. BWS is backed by Brookfield Corporation, a leading global investment firm whose asset management business manages more than $1 trillion in assets as of September 30, 2024.

We are an Equal Opportunity Employer. We do not discriminate on the basis of age, ancestry, color, gender, gender expression, gender identity, genetic information, marital status, national origin or citizenship (including language use restrictions), denial of family and medical care leave, disability (mental and physical), including HIV and AIDS, medical condition (including cancer and genetic characteristics), race, religious creed (including religious dress and grooming practices), sex (including pregnancy, childbirth, breastfeeding, and medical conditions related to pregnancy, childbirth or breastfeeding), sexual orientation, military or veteran status, or other status protected by laws or regulations in the locations where we operate. We do not tolerate discrimination or harassment based on any of these characteristics.

The collection of your personal information is subject to our HR Privacy Notice.

Our Benefits

Developing our employees professionally and personally strengthens our organization.

Argo Group offers an attractive Total Rewards package that includes:

• A culture that recognizes performance and empowers employees to excel, offering competitive compensation and merit driven profit sharing.
• Workplace policies that support employee well-being include flex time and floating holidays.
• Comprehensive health, wellness, and financial planning options that employees can tailor to meet their personal and family needs. In addition to traditional health and wellness plans, benefits include dental, disability, life insurance, medical, and vision insurance, matching 401(k) retirement savings, generous paid time off (21 days of PTO, 11 paid company holidays, 3 floating holidays and a paid voluntary day), paid caregiver and parental leave, paid bereavement, jury duty / court appearances, and military (up to 14 days) leave, employee assistance program (EAP), and an array of voluntary benefits.
• Argo Academy, a digital and instructor-led platform that offers continuous learning and professional development - Training magazine lists Argo among the Training "Top 125" Companies. Argo encourages career mobility and continuing education to pursue and maintain professional and industry designations, in addition to traditional university and higher education programs.
• An inclusive culture that develops and sponsors diverse teams, encourages cross-functional engagement and collaboration, builds community through employee resource groups (ERGs), and provides an environment that welcomes ongoing dialogue, creative innovation, professional and personal development.
• Active community outreach and volunteer programs.
• A generous Employee Referral program that results in approximately 25% of all new hires annually.