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Berkshire Hathaway GUARD

Claims Representative - Medical Only

Career Insights for Medical Claims Processor / Representative

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What they do

A Medical Claims Processor or Representative reviews and processes medical insurance claims and determines whether an insurance policy will cover a medical procedure. Gathers information from policy holders and organizes insurance files; may process checks with payments to policy holders when a medical claim is approved.

$42,879 / year median in Pennsylvania

-5% projected decline

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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