TEMP-Senior Medical Pricing Specialist

Job Description

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.

Business Title(s): TEMP
- Senior Medical Pricing Specialist

Employment Type: Temporary

FLSA Status: Non-Exempt

Location: In-Office or Remote

Summary:

We are looking for a highly capable Senior Medical Pricing Specialist to help us on a temporary assignment with an estimated end date of DATE and work from anywhere in the United States.

The Senior Medical Pricing Specialist is responsible for overseeing and coordinating the accurate processing of medical payments for Workers' Compensation (WC) claims in accordance with applicable state fee schedules. This role ensures payment accuracy, vendor compliance, and efficient bill review processes while serving as a key resource for claim staff and internal stakeholders.

As this is a temporary assignment, only government mandated benefits will be provided.

Contractors in this role are required to accurately record all hours worked and submit timesheets in accordance with company policy. Overtime may be assigned as business needs dictate, and employees are expected to work overtime when required.

• Working under technical direction and within significant limits and authority, oversee, manage, and coordinate the end-to-end processing of medical payments for WC claims in compliance with state fee schedules and regulatory requirements
• Audit and monitor bill review vendors to ensure accuracy, compliance, and adherence to contractual standards
• Collaborate with Claims staff to optimize medical bill processing workflows and resolve discrepancies
• Evaluate and reconcile daily EDI transactions for both individual and bulk medical bill payments
• Review daily reports and Explanation of Review (EOR) documentation to verify accuracy, including Federal Tax IDs, duplicate payments, and potential errors
• Investigate and resolve billing discrepancies, duplicate charges, and payment inconsistencies
• Maintain accurate data entry and reporting within systems such as Web-TDS
• Respond to medical bill inquiries and provide timely, accurate guidance to internal and external stakeholders
• Submit reconsideration requests electronically to bill review vendors as needed
• Support continuous process improvement efforts to enhance efficiency and payment accuracy
• Perform additional duties as assigned

Qualifications / Experience

Required:

• A practical knowledge of medical terms, procedures, and management along with the litigation process, as well as exceptional customer service focus typically achieved through:
  • A minimum of 2 years of experience in medical billing, medical pricing, or Workers' Compensation claims processing
  • Bachelor's degree from an accredited university required or four additional years of related experience beyond the minimum experience required above..
• 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).
• Must have excellent communication skills and the ability to build lasting relationships.
• 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.
• Successful traits (flexibility, ability to thrive in change, being resourceful on your own) necessary to work in afar paced environment that is evolving constantly.
• Excellent evaluation and strategic skills required.
• Must possess a strong customer focus.
• Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines.
• 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.
• Exhibit natural and intellectual curiosity in order to…