Medical Only Claims Representative

Berkshire Hathaway Guard; Wilkes-Barre (Luzerne County); Hybrid; USD 45,000 - 65,000; Full time

Benefits offered by this job

Hybrid schedule

Generous PTO

Benefits from day one

401(k) with matching

Tuition reimbursement

Longevity bonuses

Job summary

Berkshire Hathaway GUARD Insurance Companies in Wilkes-Barre, PA, is hiring a Medical Claims Representative. You will manage Workers' Compensation medical-only claims from initial report through resolution, coordinating with injured workers, employers and medical providers in a fast-paced hybrid environment.

The role requires proficiency with Microsoft Office, strong communication and attention to detail, plus the ability to interpret medical and legal terminology.

Qualifications

• 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.
• Licensing support for state adjuster licenses; company will assist with licensing.

Responsibilities

• 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.

Skills

Microsoft Office

Communication skills

Organizational skills

Customer service

Attention to detail

Learning mindset

Education

High School Diploma or GED

Job description

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.