Green Card Claims Analyst Jobs
Claims Analyst roles at U.S. insurance carriers, third-party administrators, and managed care organizations regularly qualify for EB-2 and EB-3 green card sponsorship through PERM labor certification. Employers must document prevailing wage compliance before filing, making early sponsorship conversations critical for foreign professionals in this field.
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Get Access To All JobsJOB SUMMARY
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
ESSENTIAL RESPONSIBILITIES
- Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
- Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
- Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
- Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
- Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
- Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
- Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
- Maintains accurate claim records.
- Other duties as assigned or requested.
Education
Required
- High School Diploma/GED
Substitutions
- None
Preferred
- Bachelor’s degree
Experience
Required
- 5 years of relevant, progressive experience in health insurance claims
- 3 years of prior experience processing 1st dollar health insurance claims
- 3 years of experience with medical terminology
Preferred
- 3 years of experience in a Stop Loss Claims Analyst role.
SKILLS
- Ability to communicate concise accurate information effectively.
- Organizational skills
- Ability to manage time effectively.
- Ability to work independently.
- Problem solving and analytical skills.
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
- Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$23.16
Pay Range Maximum:
$35.88
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
JOB SUMMARY
This job reviews, evaluates, and processes various Stop Loss (Excess Risk and Reinsurance) claims in accordance with established turnaround and quality standards. Responsible for building positive client relationships, providing education, and analyzing client claim losses as well as current issues regarding client activities; disseminates necessary information to the management. Follows up on pended claims in accordance with department standards.
ESSENTIAL RESPONSIBILITIES
- Processes daily incoming Stop Loss claims including initial entry claims or subsequent claims as needed; provides counseling to clients and assists with client service programs.
- Evaluates various claims submitted by Third Party Administrators (TPAs) and Pharmacy Benefit Managers (PBMs) on behalf of self-funded clients for compliance with the following: underlying policy provisions, federal and state regulatory guidelines, and industry standards.
- Monitors, reviews and analyzes various complex potential claims with emphasis on controlling losses through effective managed care. This includes following a departmental claim checklist to ensure eligibility is met, the payment reimbursement request is accurate by auditing the claim for duplicate line-item charges and determining if all information is available to finalize the payment request. Refers the claim to the cost containment and RxOps departments for review of high dollar charges if applicable.
- Determines whether to pend or adjudicate claims following organizational policies and procedures; finalizes and adjudicates claims up to pre-determined dollar threshold. Completes pended claim letters for incomplete, invalid, or missing claim information to TPAs, brokers, or customers utilizing the appropriate application and/or template.
- Identifies potential discrepancies in claim submissions and involves the Special Investigation Unit as necessary. Identifies issues which can be used to educate/train internal staff, streamline, and improve processes and update documentation.
- Assists leadership with performing client performance evaluations to assess the accuracy of client reports submitted to the organization, efficiency of claim operations, and adequacy of systems and procedures.
- Approves claim payments on behalf of multiple clients and provides client counseling and support services. Assists in the client service programs including revising and establishing procedures, protocols and ensuring client satisfaction with the organization.
- Maintains accurate claim records.
- Other duties as assigned or requested.
Education
Required
- High School Diploma/GED
Substitutions
- None
Preferred
- Bachelor’s degree
Experience
Required
- 5 years of relevant, progressive experience in health insurance claims
- 3 years of prior experience processing 1st dollar health insurance claims
- 3 years of experience with medical terminology
Preferred
- 3 years of experience in a Stop Loss Claims Analyst role.
SKILLS
- Ability to communicate concise accurate information effectively.
- Organizational skills
- Ability to manage time effectively.
- Ability to work independently.
- Problem solving and analytical skills.
Language (Other than English):
None
Travel Requirement:
0% - 25%
PHYSICAL, MENTAL DEMANDS and WORKING CONDITIONS
Position Type
- Office-based
Teaches / trains others regularly
Occasionally
Travel regularly from the office to various work sites or from site-to-site
Rarely
Works primarily out-of-the office selling products/services (sales employees)
Never
Physical work site required
Yes
Lifting: up to 10 pounds
Constantly
Lifting: 10 to 25 pounds
Occasionally
Lifting: 25 to 50 pounds
Rarely
Disclaimer: The job description has been designed to indicate the general nature and essential duties and responsibilities of work performed by employees within this job title. It may not contain a comprehensive inventory of all duties, responsibilities, and qualifications required of employees to do this job.
Compliance Requirement: This job adheres to the ethical and legal standards and behavioral expectations as set forth in the code of business conduct and company policies.
As a component of job responsibilities, employees may have access to covered information, cardholder data, or other confidential customer information that must be protected at all times. In connection with this, all employees must comply with both the Health Insurance Portability Accountability Act of 1996 (HIPAA) as described in the Notice of Privacy Practices and Privacy Policies and Procedures as well as all data security guidelines established within the Company’s Handbook of Privacy Policies and Practices and Information Security Policy.
Furthermore, it is every employee’s responsibility to comply with the company’s Code of Business Conduct. This includes but is not limited to adherence to applicable federal and state laws, rules, and regulations as well as company policies and training requirements.
Pay Range Minimum:
$23.16
Pay Range Maximum:
$35.88
Base pay is determined by a variety of factors including a candidate’s qualifications, experience, and expected contributions, as well as internal peer equity, market, and business considerations. The displayed salary range does not reflect any geographic differential Highmark may apply for certain locations based upon comparative markets.
Highmark Health and its affiliates prohibit discrimination against qualified individuals based on their status as protected veterans or individuals with disabilities and prohibit discrimination against all individuals based on any category protected by applicable federal, state, or local law.
We endeavor to make this site accessible to any and all users. If you would like to contact us regarding the accessibility of our website or need assistance completing the application process, please contact the email below.
For accommodation requests, please contact HR Services Online at HRServices@highmarkhealth.org
California Consumer Privacy Act Employees, Contractors, and Applicants Notice
See all 161+ Green Card Claims Analyst Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Green Card Claims Analyst Jobs.
Get Access To All JobsTips for Finding Green Card Sponsorship as a Claims Analyst
Translate your credentials into PERM language
PERM applications require your employer to state a minimum education requirement. If your claims analysis background includes a foreign degree, get a credential evaluation that maps it to a U.S. bachelor's equivalency before your employer drafts the job description.
Target employers with PERM filing history
Insurance carriers and claims management firms that have filed PERM applications before already understand the DOL recruitment and documentation requirements. Searching OFLC disclosure data for past Claims Analyst certifications narrows your list to employers with proven sponsorship infrastructure.
Use Migrate Mate to find green card sponsoring roles
Filtering job searches by green card sponsorship history cuts through noise fast. Migrate Mate surfaces Claims Analyst openings at employers with active EB-2 and EB-3 filing records, so you're applying to companies already set up for the PERM process.
Clarify the EB-2 versus EB-3 track with your employer
Claims Analyst roles typically qualify under EB-3 as skilled workers, but positions requiring actuarial analysis or an advanced degree in risk management may support an EB-2 petition. Confirm which classification your offer letter and job duties support before PERM filing begins.
Understand the PERM recruitment window before negotiating your start date
DOL requires employers to complete a specific recruitment process before filing a PERM application, which typically runs 30 to 60 days. Factor this window into your offer negotiation so your start date doesn't create pressure to skip or rush the mandatory documentation steps.
Request a priority date strategy from your employer early
For nationals of high-backlog countries, the gap between I-140 approval and visa availability can span years. Ask your employer whether they'll file a concurrent I-485 if your priority date is current, so you can maintain work authorization continuity through the adjustment of status process.
Green Card Claims Analyst: Frequently Asked Questions
Does a Claims Analyst role typically qualify for EB-2 or EB-3 sponsorship?
Most Claims Analyst positions qualify under EB-3 as skilled workers, since they generally require a bachelor's degree but not an advanced degree. If your role involves complex data modeling, actuarial functions, or your employer is willing to require a master's degree in the job description, EB-2 may apply. Your employer's immigration counsel determines which classification fits the actual duties and minimum requirements.
How does green card sponsorship differ from H-1B sponsorship for this role?
H-1B visa sponsorship is temporary, subject to an annual lottery, and tied to nonimmigrant intent. Green card sponsorship through PERM and I-140 is permanent, has no annual cap at the petition stage, and results in lawful permanent residency. The tradeoff is timeline: PERM labor certification and I-140 adjudication add months before you can file to adjust status, and visa availability varies by country of birth.
What does the PERM process mean for a Claims Analyst job offer?
PERM requires your employer to conduct a DOL-supervised recruitment process to demonstrate no qualified U.S. workers were available for your role. They must file wage documentation showing your offered salary meets the prevailing wage for Claims Analysts in your geographic area, which you can verify independently using the OFLC Wage Search tool. The full PERM process typically takes six to twelve months before an I-140 petition can be filed.
How can I find Claims Analyst jobs that include green card sponsorship?
Most job postings don't explicitly state PERM sponsorship availability. Migrate Mate lets you search Claims Analyst openings filtered by employers with documented EB-2 or EB-3 filing history, which gives you a targeted list of companies already set up to sponsor rather than relying on employers self-reporting sponsorship willingness in a job ad.
Can I switch jobs after my employer files my PERM application?
Leaving your sponsoring employer before your I-140 is approved generally restarts the process, since PERM certification is tied to that employer and that specific role. Once your I-140 has been approved for at least 180 days, AC21 portability allows you to move to a same or similar occupation without losing your priority date, provided your I-485 is already pending.