Medical Claims / Repricing Associate

Good things are happening at Berkshire Hathaway GUARD Insurance Companies. We provide Property & Casualty insurance products and services through a nationwide network of independent agents and brokers. Our companies are all rated A+ “Superior” by AM Best (the leading independent insurance rating organization) and ultimately owned by Warren Buffett’s Berkshire Hathaway group – one of the financially strongest organizations in the world! Headquartered in Wilkes-Barre, PA, we employ over 1,000 individuals (and growing) and have offices across the country. Our vision is to be a leading small business insurance provider nationwide.

Founded upon an exceptional culture and led by a collaborative and inclusive management team, our company’s success is grounded in our core values:  accountability, service, integrity, empowerment, and diversity. We are always in search of talented individuals to join our team and embark on an exciting career path!

Benefits:

We are an equal opportunity employer that strives to maintain a work environment that is welcoming and enriching for all. You’ll be surprised by all we have to offer!

• Competitive compensation
• Healthcare benefits package that begins on first day of employment
• 401K retirement plan with company match
• Enjoy generous paid time off to support your work-life balance plus 9 ½ paid holidays
• Up to 6 weeks of parental and bonding leave
• Hybrid work schedule (3 days in the office, 2 days from home)
• Longevity awards (every 5 years of employment, receive a generous monetary award to be used toward a vacation)
• Tuition reimbursement after 6 months of employment
• Numerous opportunities for continued training and career advancement
• And much more!

The Medical Claims/Repricing Associate is an integral part of our Workers' Compensation department and will be responsible for analyzing billing information, verification of ICD-10 and CPT-4 codes, and submission of reconsiderations.

• Research, respond, and track inquiries in a timely manner that come into the Provider Relations mailbox 
• Conduct quality assurance on invoices
• Provide customer service for our providers (Doctor Offices & Hospitals)
• Answer inbound calls from external medical providers
• Have the ability to work within turnaround time standards so claims team can meet prompt pay claim requirements per State Law 
• Have the ability to review proper coding ICD-10, CPT, and HCPCS codes

Required:

• Solid understanding of medical coding (ICD-10, CPT, HCPCS)
• Knowledge of workers compensation state rules and regulations
• Strong attention to detail, organizational and problem-solving abilities
• California adjuster's license (must be willing to obtain at the company's expense following time of hire)
• High School Diploma/GED