Claims Specialist

• Manually review and process medical, supplemental, or dental claims
• Process claims according to benefits, eligibility, and internal processes, policies, and procedures
• Complete, hold for additional information or review, or deny claims as appropriate
• Research and navigate documents and databases to process claims accurately and compliantly
• Confirm necessary documents are present in submitted claims
• Validate medical codes in claim submissions
• Assess claim eligibility
• Review and verify other insurance coverage information
• Evaluate authorizations for accuracy
• Analyze account benefit plans to ensure claims align with coverage and policies
• Identify discrepancies, errors, and missing information
• Use multiple computer applications simultaneously
• Meet or exceed quality and productivity goals
• Work with supervisors, coaches, and trainers to improve processing techniques and workflows
• Use Outlook, Cisco Webex, and similar virtual tools to collaborate and communicate with colleagues and supervisors
• Complete a robust training program and meet accuracy, quality, volume, claims-per-hour, and production metrics after training

Claims Representative

• Manage Workers' Compensation medical-only claims from initial report through resolution
• Determine compensability and ensure timely delivery of benefits
• Coordinate medical treatment and facilitate early return-to-work efforts
• Review and process medical bills for payment
• Serve as a liaison between injured workers, employers, and medical providers
• Provide guidance regarding Workers' Compensation processes and claim management
• Maintain accurate claim documentation and comply with applicable regulations and company procedures

Medical Only Claims Representative

• Manage Workers' Compensation medical-only claims from initial report through resolution
• Determine compensability and ensure timely delivery of benefits
• Coordinate medical treatment and facilitate early return-to-work efforts
• Review and process medical bills for payment
• Serve as a liaison between injured workers, employers, and medical providers
• Provide guidance regarding Workers' Compensation processes and claim management
• Maintain accurate claim documentation and comply with applicable regulations and company procedures
• Provide timely service to injured workers, employers, and medical providers
• Communicate, coordinate, and administer Workers' Compensation claims

Overview

Good Things Start Here.

Good things are happening at Berkshire Hathaway GUARD Insurance Companies—an A+ (Superior) rated, nationwide Property & Casualty insurer backed by Berkshire Hathaway. With supportive leadership, collaborative teams, and opportunities to grow, GUARD is a place where people build meaningful, long‑term careers.

Good Things You Can Count On.

- Hybrid schedule: 2 days remote / 3 in‑office

- Predictable hours (no nights, weekends, or holidays)

- Competitive pay + generous PTO

- Medical, dental & vision starting day one

- 401(k), tuition reimbursement & longevity bonuses

Responsibilities

The Medical Claims Representative manages Workers' Compensation medical-only claims while providing timely service to injured workers, employers, and medical providers. This role is responsible for the communication, coordination and administration of Workers’ Compensation claims.

- Manage Workers' Compensation medical-only claims from initial report through resolution.

- Determine compensability and ensure timely delivery of benefits.

- Coordinate medical treatment and facilitate early return-to-work efforts.

- Review and process medical bills for payment.

- Serve as a liaison between injured workers, employers, and medical providers.

- Provide guidance regarding Workers' Compensation processes and claim management.

- Maintain accurate claim documentation and comply with applicable regulations and company procedures.

Qualifications

Candidate must have:

- Proficiency with Microsoft Office applications and other business technologies

- Strong communication, organizational, and customer service skills

- Ability to understand and apply medical and legal terminology related to Workers' Compensation claims

- Strong attention to detail 

- Ability to learn new technology and systems

- High School Diploma/GED required; additional education or relevant claims experience is a plus

- Licensing Requirement: Candidates must hold an active adjuster license or be willing and able to obtain and maintain all required state licenses. The company will support the licensing process, including cost, training and compliance with ongoing continuing education requirements

Interview Integrity Notice: Berkshire Hathaway GUARD is committed to a fair and consistent hiring process. Candidates are expected to participate independently in interviews. Unauthorized recording, transcription, AI note-taking, or AI interview assistance tools may not be used during interviews without prior approval.

Workers' Compensation Medical Claims Representative

Overview

Good Things Start Here.

Good things are happening at Berkshire Hathaway GUARD Insurance Companies—an A+ (Superior) rated, nationwide Property & Casualty insurer backed by Berkshire Hathaway. With supportive leadership, collaborative teams, and opportunities to grow, GUARD is a place where people build meaningful, long‑term careers.

Good Things You Can Count On.

- Hybrid schedule: 2 days remote / 3 in‑office

- Predictable hours (no nights, weekends, or holidays)

- Competitive pay + generous PTO

- Medical, dental & vision starting day one

- 401(k), tuition reimbursement & longevity bonuses

Responsibilities

We are seeking a Medical Claims Representative in our Wilkes-Barre, PA office to manage Workers' Compensation medical-only claims while providing timely service to injured workers, employers, and medical providers. This role is responsible for the communication, coordination and administration of Workers’ Compensation claims.

- Manage Workers' Compensation medical-only claims from initial report through resolution.

- Determine compensability and ensure timely delivery of benefits.

- Coordinate medical treatment and facilitate early return-to-work efforts.

- Review and process medical bills for payment.

- Serve as a liaison between injured workers, employers, and medical providers.

- Provide guidance regarding Workers' Compensation processes and claim management.

- Maintain accurate claim documentation and comply with applicable regulations and company procedures.

Qualifications

Candidate must have:

- Proficiency with Microsoft Office applications and other business technologies

- Strong communication, organizational, and customer service skills

- Ability to understand and apply medical and legal terminology related to Workers' Compensation claims

- Strong attention to detail 

- Ability to learn new technology and systems

- High School Diploma/GED required; additional education or relevant claims experience is a plus

- Licensing Requirement: Candidates must hold an active adjuster license or be willing and able to obtain and maintain all required state licenses. The company will support the licensing process, including cost, training and compliance with ongoing continuing education requirements

Interview Integrity Notice: Berkshire Hathaway GUARD is committed to a fair and consistent hiring process. Candidates are expected to participate independently in interviews. Unauthorized recording, transcription, AI note-taking, or AI interview assistance tools may not be used during interviews without prior approval.