Workers Compensation Claims Operations Specialist

Berkshire Hathaway GUARD Insurance Companies•Wilkes-Barre, PA

2d•Hybrid

About The Position

Berkshire Hathaway GUARD Insurance Companies is seeking a Workers' Compensation Claims Operations Specialist to support and enhance the performance of its Workers' Compensation Claims operation. The role partners closely with Claims leadership to improve operational effectiveness, drive process improvement initiatives, establish quality controls, and support strategic projects aligned with broader Property & Casualty Claims objectives. The ideal candidate combines Workers' Compensation claims expertise with analytical skills, process improvement experience, and a focus on operational excellence. The position has a hybrid schedule of two remote days and three in-office days. Hours are predictable, with no nights, weekends, or holidays. The role is ideally based in Wilkes-Barre, Pennsylvania.

Requirements

Bachelor's degree or equivalent experience required.
Strong understanding of Workers' Compensation claims handling and adjudication practices.
Demonstrated ability to analyze complex issues, identify root causes, and develop effective solutions.
Excellent written and verbal communication skills.
Strong organizational and project management abilities.
Ability to manage multiple priorities in a fast-paced environment.
Proficiency with Microsoft Office applications, including Excel, Word, PowerPoint, and Access.

Nice To Haves

Five or more years of Workers' Compensation claims experience preferred.
Experience driving process improvement, operational excellence, or quality initiatives is highly desirable.

Responsibilities

Partner with Claims leadership to support daily operations and long-term strategic initiatives.
Establish and monitor quality assurance programs, claims audits, and performance reporting.
Identify trends, recurring issues, and workflow bottlenecks, and implement corrective actions.
Collaborate with training partners to address skill gaps and improve team performance.
Work with medical networks, cost containment partners, investigative vendors, and other claim service providers to resolve issues and strengthen outcomes.
Partner with Compliance to maintain audit-ready processes, documentation, and reporting.
Collaborate with IT to enhance workflows, reporting, business rules, and system functionality.
Develop scalable, documented processes that improve efficiency and reduce manual effort.
Lead or support initiatives that improve claims performance, service delivery, and operational standards.