Medical Only Claims Representative

careers-guard; Wilkes-Barre (Luzerne County); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

Hybrid schedule

Predictable hours

Competitive pay + generous PTO

Medical, dental & vision starting day

401(k) and tuition reimbursement

Longevity bonuses

Job summary

Berkshire Hathaway GUARD Insurance Companies is seeking a Medical Claims Representative to manage Workers' Compensation medical-only claims from report to resolution. The role emphasizes timely service to injured workers, employers, and medical providers.

Qualifications include MS Office proficiency, strong communication, and knowledge of medical/legal terminology. A high school diploma is required, with licensing support offered by the company for state-adjuster licenses.

Qualifications

• MS Office proficiency and strong communication skills are essential.
• Ability to understand and apply medical and legal terminology related to Workers' Compensation claims.
• Attention to detail and the capacity to learn new technology.
• Active adjuster license or ability to obtain and maintain state licenses with company support.

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 regulations and procedures.

Skills

MS Office proficiency

Strong communication

Medical/Legal terminology

Attention to detail

Learning new technology

Active adjuster license

Education

High School Diploma or GED

Tools

Microsoft Office

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.