Claims Representative - Medical Only

Job Title

Medical Claims Representative

Job Description

Good things are happening at Berkshire Hathaway GUARD Insurance Companiesan 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.

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