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About the Role

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.

Responsibilities

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

Requirements

A practical knowledge of medical terms, procedures, and management along with the litigation process, as well as exceptional customer service focus
A minimum of 2 years of experience in medical billing, medical pricing, or Workers’ Compensation claims processing
Bachelor’s degree from an accredited university or four additional years of related experience beyond the minimum experience required
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
A strong focus on execution in getting things done right
Proven ability to consistently produce and deliver expected results to all stakeholders
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 a fast paced environment that is constantly evolving
Excellent evaluation and strategic skills
A strong customer focus
Effective time management skills and ability to prioritize workload while handling multiple tasks and deadlines
Ability to work independently and demonstrate the ability to exercise sound judgment
Demonstrates inner strength, courage to do the right thing
Exhibit natural and intellectual curiosity in order to consistently explore and consider 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
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

Skills

Medical billing
Medical pricing
Workers’ Compensation claims processing
MS Office Suite
Business-related software

Location

In-Office or Remote
United States

Work Type

Temporary
Non-Exempt

Experience Level

Senior

Education Level

Bachelor’s degree or equivalent experience

Salary/Compensations

Colorado outside of Denver metro, Delaware, Illinois (outside of Chicago metro area), Maine, Maryland, Massachusetts (outside of Boston metro area), Minnesota, Nevada, Rhode Island, Vermont, and Virginia Pay Ranges: $37.66 per hour - $44.33 per hour
Boston metro area, California outside of Los Angeles & San Francisco metro area, Connecticut, Chicago metro area, Denver metro area, New Jersey (outside of New York City metro area), New York State (outside of New York City metro area), Washington, D. C. metro area, & Washington State Pay Ranges: $41.44 per hour - $48.79 per hour
New York City, Los Angeles and San Francisco metro areas Pay Ranges: $45.16 per hour - $53.16 per hour

Benefits

Government mandated benefits
Health
Dental
Vision
401(k) with company match
Paid time off
Professional development opportunities

About the Company

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

Equal Opportunity

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.