Workers' Compensation Claims Trainee

Argonaut Management Services, Inc; Omaha (NE); On-site; USD 42,000 - 62,000; Full time

Job summary

Argo Group seeks a Workers' Compensation Claims Trainee to adjudicate medical-only and select indemnity claims, working from home in New Mexico or from our Omaha office. The role reports to a manager based in Rockwood, PA and emphasizes timely, accurate claim handling with strong communication across stakeholders.

Responsibilities include contacting insureds, providers, and claimants; recording hours; and ensuring proper reserves and benefits.

Qualifications

• Advanced knowledge of medical-only workers' compensation claims.
• 6+ years adjudicating medical-only claims or in insurance/healthcare, bachelor’s may substitute 5 of 6 years.
• Licensed Claims Examiner in required jurisdictions or ability to obtain within 120 days.
• Strong communication and relationship-building skills.
• Proficient in MS Office and related business software.

Responsibilities

• Conduct thorough claim investigations by interviewing involved parties to determine compensability and subrogation potential.
• Manage medical-only and Black Lung claims and monitor biweekly or monthly benefit payments.
• Deny noncompensable claims and defend decisions if challenged.
• Ensure timely and accurate medical payments and proper reserve setting.
• Maintain diaries and prioritize tasks to resolve cases timely and financially.

Skills

MS Office Suite

Strong communication

Analytical thinking

Time management

Customer focus

Spanish (pref)

Education

High School diploma

Licensed Claims Examiner

Bachelor’s degree substitution clause

Tools

Medical terminology familiarity

Job description

Company

Argo Group

Argo Group is an underwriter of specialty insurance products in the property and casualty market. Argo offers a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses. The Argo entities are wholly-owned subsidiaries of Clearbrook Group Holdings Inc.

Job Description

Business Title(s):

Workers' CompensationClaims Trainee

Employment Type:

Regular

FLSA Status:

Non-Exempt

Location:

Field(New Mexico Only) or In-Office

Any Argo or Farm Family employee, working in any Clearbrook office, can apply for this role and remain working in their current office location.

Summary:

We are looking for a highly capable Workers' Compensation Claims Adjuster Trainee to join our team and work from their home in New Mexico or from our Omaha office. The position reports to a manager based in Rockwood, PA and initially will be focused onadjudicatingmedical-only claims and will eventually be trained onadjudicatinglow 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. Under close supervision, this role investigates compensability, conducts claimant, employer, and provider outreach (including required aliveandwell checks), sets reserves, denies noncompensable claims, and ensuresappropriate medicalpayments are madetimelyand accurately. The position emphasizes strong claim management fundamentals,timelyresolution, thorough documentation, and consistent communication with all claim stakeholders. Our Adjusters contribute to providing superb results for our clients.

Although Argo Workers' Compensation underwrites general liability insurance and workers' compensation for many types of businesses, our specialty is 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.

Employees in this role willbe requiredto accurately record all hours worked andsubmittimesheetsin accordance withcompany policy. Overtime may be assigned as business needs to dictate, and employees are expected to work overtime whenrequired.

This is a classified as a field position in New Mexico only; otherwise it is an in-office position.

Essential Responsibilities:

• Under close supervision and guidance, works within narrowly defined limits with an impact on departmental results. This requires conducting thorough claim investigations by interviewing injured workers, insured employers, medical providers, and other relevant parties todeterminecompensability issues and subrogation potential.
• Manage medicalonly claims, including Federal and State Black Lung claims that have already been reviewed and a schedule of benefits approved by the Department of Labor.
• Completing required aliveandwell checks for Black Lung claims and monitoring of biweekly or monthly benefit payments.
• Resolving issues that are generalized and typically notimmediatelyevident, but typically not complex and within immediate jobarea.
• Denying any claims that are not covered or do not meet compensability criteria and successfully defending that decision if challenged.
• Actively managemedical onlyclaims to ensure only medical billsappropriate tothe claim are paid ona timelybasis.
• Managing a diary and completing tasks to ensure that cases areresolvedtimelyand at the right financial outcome.
• Properly setting claim reserves.
• Identifyingand directing the assignment and coordination ofexpertiseresources toassistin case resolution.
• Preparing reports for file documentation
• Processing mail and prioritizing workload.
• Responsible for telephone calls from various parties (insured, claimant, etc.).
• Having an appreciation and passion for strong claim management

Qualifications / Experience Required:

• An advanced knowledge of medical only workers' compensation claims typically achieved through:
  • High School diploma
  • At least sixyears' experienceadjudicatingmedical onlyclaims or in the insurance or healthcare industry (preferably in a commercial claim department) isrequired, as is familiarity with medical terminology.A bachelor's degree from an accredited university can be used to substitute 5 of the 6 years of work experience.
• 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).
• 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
• Beingsolution (not problem) focused
• Must have excellent communication skills and the ability to build lasting relationships.
• Exhibitnatural and intellectual curiosityin order toconsistently explore and consider all options and is not governed by conventional thinking.
• Desireto work in a fast-paced environment.
• Excellent evaluation and strategic skillsrequired.
• Mustpossessa strong customer focus.
• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
• Must be tenacious in ability to investigate claims by interviewing injuredworker,employer, witnesses, and healthcare providers and researching coverage issues and potential subrogation opportunities.
• The ability to read, speak, and write English fluently isrequired. Polished and professional telephone communication skills are essential.
• 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.
• Demonstratesinner strength.
• Has the courage to do the right thing anddemonstratesiton a daily basis.
• Proficient in MS Office Suite and other business-related software.
• Mustdemonstratea desire for continued professional development through continuing education and self-development opportunities.
• Licensed Claims Examiner (Based on state) Must be licensed or have ability to quickly obtain a license in eachjurisdictionrequiring a license toadjudicatefirst party claims within 120 Day

Preferred Qualifications:

• The ability to read and write Spanish fluently is notrequiredbut ispreferred.
• 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 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 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:

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.

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

Benefits and Compensation

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.

Core Values

At Clearbrook our Core Values are Integrity, Collaboration, Pursuit of Excellence and Forward Thinking. These values reflect who we are today and who we aspire to be - guiding how we work, how we lead and how we succeed.