Workers' Comp Claims Specialist (Hybrid)

Berkshire Hathaway GUARD Insurance Companies; Wilkes-Barre (Luzerne County); Hybrid; USD 42,000 - 60,000; Full time

Benefits offered by this job

Hybrid schedule: 2 days remote / 3 in‑

Predictable hours (no nights, weekends

Competitive pay + generous PTO

Medical, dental & vision starting day

401(k), tuition reimbursement & Lon g

Job summary

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

This role emphasizes communication, coordination and administration of claims from initial report through resolution, with responsibilities including determining compensability, coordinating treatment, and maintaining thorough documentation.

Qualifications

• Proficiency with Microsoft Office and business technologies.
• Strong communication, organizational and customer service skills.
• Ability to understand medical and legal terminology related to Workers' Compensation claims.
• High School Diploma or GED required; relevant claims experience is a plus.
• 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 company procedures.

Skills

Microsoft Office

Communication skills

Organizational skills

Customer service

Medical terminology

Education

High School Diploma or GED

Active adjuster license

Job description

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

This role emphasizes communication, coordination and administration of claims from initial report through resolution, with responsibilities including determining compensability, coordinating treatment, and maintaining thorough documentation.