Medical Claims Examiner Green Card Jobs
Medical Claims Examiner roles qualify for EB-2 and EB-3 green card sponsorship through the PERM labor certification process, where employers document that no qualified U.S. worker is available before filing an I-140 petition. Health insurers, third-party administrators, and managed care organizations regularly sponsor foreign professionals in this role.
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Get Access To All JobsINTRODUCTION
The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, and Data Infrastructure. The SIU ensures that Clover monitors, identifies, and investigates instances of healthcare fraud, waste and abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA!
ABOUT THE ROLE
As a Medical Claims Auditor within our Special Investigations Unit, you will play a critical role in ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your policy and operational skills. A successful Medical Claims Auditor will have a broad coding knowledge base, including but not limited to: DME, Outpatient, ASC and Physician correct coding. This position will focus specifically on Medicare coding policies.
YOUR ROLE AND RESPONSIBILITIES
As a Medical Claims Auditor, you will:
- Partner with Clinical, Claims, and SIU peers to review claims for billing and coding related issues on a retrospective basis that currently drive inaccurate payments to providers or indicate FWA.
- Identify control opportunities to mitigate FWA.
- Identify possible audit opportunities.
- Support annual FWA audit goals.
- Support provider conversations around FWA audit findings.
- Manage overall audit workload to ensure timely and accurate audit results.
- Work closely with senior team members and management on targeted projects and initiatives.
- Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.
SUCCESS IN THIS ROLE LOOKS LIKE
- By the end of your initial 90 day period, you will have demonstrated a strong understanding of our review process and are able to effectively navigate through the various Clover systems.
- By 6 months, you will be working autonomously on provider reviews.
- Continued success in this position anchors in on developing a deep understanding of the workflows that support our SIU cases and reviews while maintaining regulatory compliance standards.
BASIC QUALIFICATIONS
- You have 3+ years of coding and auditing experience, experience with CMS regulations preferred.
- Certified Professional Coder (CPC) or other coding certification is a plus.
- You have a strong knowledge of the National Rules of Correct Codification defined by CMS in the Manual of CCI and the tables of CCI.
- You have experience working in a technology environment including claims systems, workflow management tools, Microsoft Office or Google Suite.
- You have prior experience working in health insurance; Medicare Advantage is a plus.
BENEFITS OVERVIEW
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
ABOUT CLOVER
We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
A reasonable estimate of the base salary range for this role is:
$90,000—$100,000 USD
INTRODUCTION
The Special Investigation Unit (SIU) is a motivated, collaborative team sitting at the intersection of Compliance, Payment Integrity, and Data Infrastructure. The SIU ensures that Clover monitors, identifies, and investigates instances of healthcare fraud, waste and abuse (FWA). Come join us as we discover new opportunities to enhance the fight against FWA!
ABOUT THE ROLE
As a Medical Claims Auditor within our Special Investigations Unit, you will play a critical role in ensuring that Clover is able to continue to build and scale a compliant, effective FWA audit program. You will be joining a fast-growing and fast-moving startup at the intersection of healthcare and technology, where you will have the opportunity to develop both your policy and operational skills. A successful Medical Claims Auditor will have a broad coding knowledge base, including but not limited to: DME, Outpatient, ASC and Physician correct coding. This position will focus specifically on Medicare coding policies.
YOUR ROLE AND RESPONSIBILITIES
As a Medical Claims Auditor, you will:
- Partner with Clinical, Claims, and SIU peers to review claims for billing and coding related issues on a retrospective basis that currently drive inaccurate payments to providers or indicate FWA.
- Identify control opportunities to mitigate FWA.
- Identify possible audit opportunities.
- Support annual FWA audit goals.
- Support provider conversations around FWA audit findings.
- Manage overall audit workload to ensure timely and accurate audit results.
- Work closely with senior team members and management on targeted projects and initiatives.
- Communicate effectively while building trust and lasting partnerships both laterally and vertically across multi-discipline teams.
SUCCESS IN THIS ROLE LOOKS LIKE
- By the end of your initial 90 day period, you will have demonstrated a strong understanding of our review process and are able to effectively navigate through the various Clover systems.
- By 6 months, you will be working autonomously on provider reviews.
- Continued success in this position anchors in on developing a deep understanding of the workflows that support our SIU cases and reviews while maintaining regulatory compliance standards.
BASIC QUALIFICATIONS
- You have 3+ years of coding and auditing experience, experience with CMS regulations preferred.
- Certified Professional Coder (CPC) or other coding certification is a plus.
- You have a strong knowledge of the National Rules of Correct Codification defined by CMS in the Manual of CCI and the tables of CCI.
- You have experience working in a technology environment including claims systems, workflow management tools, Microsoft Office or Google Suite.
- You have prior experience working in health insurance; Medicare Advantage is a plus.
BENEFITS OVERVIEW
- Financial Well-Being: Our commitment to attracting and retaining top talent begins with a competitive base salary and equity opportunities. Additionally, we offer a performance-based bonus program, 401k matching, and regular compensation reviews to recognize and reward exceptional contributions.
- Physical Well-Being: We prioritize the health and well-being of our employees and their families by providing comprehensive medical, dental, and vision coverage. Your health matters to us, and we invest in ensuring you have access to quality healthcare.
- Mental Well-Being: We understand the importance of mental health in fostering productivity and maintaining work-life balance. To support this, we offer initiatives such as No-Meeting Fridays, monthly company holidays, access to mental health resources, and a generous flexible time-off policy. Additionally, we embrace a remote-first culture that supports collaboration and flexibility, allowing our team members to thrive from any location.
- Professional Development: Developing internal talent is a priority for Clover. We offer learning programs, mentorship, professional development funding, and regular performance feedback and reviews.
Additional Perks:
- Employee Stock Purchase Plan (ESPP) offering discounted equity opportunities
- Reimbursement for office setup expenses
- Monthly cell phone & internet stipend
- Remote-first culture, enabling collaboration with global teams
- Paid parental leave for all new parents
- And much more!
ABOUT CLOVER
We are reinventing health insurance by combining the power of data with human empathy to keep our members healthier. We believe the healthcare system is broken, so we've created custom software and analytics to empower our clinical staff to intervene and provide personalized care to the people who need it most.
We always put our members first, and our success as a team is measured by the quality of life of the people we serve. Those who work at Clover are passionate and mission-driven individuals with diverse areas of expertise, working together to solve the most complicated problem in the world: healthcare.
From Clover’s inception, Diversity & Inclusion have always been key to our success. We are an Equal Opportunity Employer and our employees are people with different strengths, experiences, perspectives, opinions, and backgrounds, who share a passion for improving people's lives. Diversity not only includes race and gender identity, but also age, disability status, veteran status, sexual orientation, religion and many other parts of one’s identity. All of our employee’s points of view are key to our success, and inclusion is everyone's responsibility.
LI-REMOTE
Pursuant to the San Francisco Fair Chance Ordinance, we will consider for employment qualified applicants with arrest and conviction records. We are an E-Verify company.
A reasonable estimate of the base salary range for this role is:
$90,000—$100,000 USD
See all 24+ Medical Claims Examiner jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Medical Claims Examiner roles.
Get Access To All JobsTips for Finding Green Card Sponsorship in Medical Claims Examiner
Credential your healthcare billing certifications first
PERM requires your employer to prove your qualifications meet the posted job requirements. A Certified Professional Coder or Certified Claims Examiner credential on your resume strengthens the employer's case and reduces RFE risk on the I-140.
Target TPAs and self-insured employer plans
Third-party administrators and large self-insured plan sponsors process high claims volumes and maintain dedicated HR infrastructure for employment-based sponsorship. They're more likely to have established PERM workflows than smaller regional carriers.
Check the OFLC Wage Search before salary discussions
PERM filings must meet the DOL prevailing wage for your specific SOC code and geographic area. Reviewing the OFLC Wage Search before negotiating your offer ensures the employer's proposed salary is certifiable and avoids delays at the labor certification stage.
Use Migrate Mate to find verified green card sponsors
Search for Medical Claims Examiner roles with documented EB-2 and EB-3 filing history using Migrate Mate. The platform surfaces employers who have previously completed PERM certifications for this role, so you're not guessing at sponsorship willingness.
Clarify sponsorship timing before accepting any offer
Ask your prospective employer whether they initiate PERM during your first year or only after a probationary period. Delays past the second year can affect your priority date and complicate your timeline if you're currently on a temporary work status.
Request EB-3 filing if your degree is a bachelor's
Medical Claims Examiner roles typically qualify under EB-3 as a skilled worker or professional. If your employer's immigration counsel initially proposes EB-2, confirm that your degree and experience actually satisfy the advanced-degree standard to avoid a USCIS denial on classification grounds.
Medical Claims Examiner jobs are hiring across the US. Find yours.
Find Medical Claims Examiner JobsMedical Claims Examiner Green Card Sponsorship: Frequently Asked Questions
Do Medical Claims Examiner roles typically qualify for EB-2 or EB-3 green card sponsorship?
Most Medical Claims Examiner positions qualify under EB-3 as skilled workers or professionals, requiring at least a bachelor's degree or two years of specialized training. EB-2 sponsorship is available if the employer genuinely requires an advanced degree for the role and can document that requirement. Your employer's immigration counsel will determine the correct classification based on the actual job duties and minimum requirements posted during the PERM recruitment process.
How does green card sponsorship differ from H-1B sponsorship for this role?
Unlike H-1B, employment-based green card sponsorship through PERM leads to permanent residency rather than a temporary status with renewal requirements. There is no annual lottery for EB-3 green cards, and most countries outside India and China face no significant backlog at that preference level. The process takes longer overall, typically two to four years from PERM filing to an approved I-485 for most nationalities, but the outcome is lawful permanent residency rather than a capped, renewable work authorization period.
What does the PERM labor certification process require from a Medical Claims Examiner applicant?
Your employer conducts the PERM process, not you, but your qualifications directly affect it. DOL requires the employer to advertise the role and demonstrate no qualified U.S. worker was available. Your credentials, including claims processing experience and any healthcare billing certifications, must match the minimum requirements posted in those recruitment steps. Any discrepancy between your actual credentials and the posted requirements can cause a denial or audit at the PERM stage.
How do I find Medical Claims Examiner employers who actively sponsor green cards?
Start with Migrate Mate, which aggregates employer green card filing history so you can identify health insurers, third-party administrators, and managed care organizations that have completed PERM certifications for this specific role. Targeting employers with a documented sponsorship record is significantly more efficient than applying broadly and asking during interviews, where sponsorship questions can be interpreted as premature.
Can I switch jobs after my I-140 is approved but before my green card is issued?
Yes, under AC21 portability provisions, you can change employers after your I-140 has been approved and your I-485 has been pending for at least 180 days, provided the new role is in the same or a similar occupational classification. For Medical Claims Examiner positions, a move to a comparable claims review or healthcare administration role at a different insurer or TPA generally satisfies the portability standard. You should consult an immigration attorney before changing employers to confirm the new role qualifies.
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