H-1B Visa Claims Analyst Jobs
Claims Analyst roles qualify for H-1B visa sponsorship when the position requires a bachelor's degree in a field like finance, business administration, or data analytics. Insurance carriers, third-party administrators, and healthcare payers are the most active sponsors. No lottery exemptions apply, so timing your job search around the April filing window matters.
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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 143+ H-1B Visa Claims Analyst Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new H-1B Visa Claims Analyst Jobs.
Get Access To All JobsTips for Finding H-1B Visa Sponsorship as a Claims Analyst
Frame your degree around specialty occupation
USCIS requires a direct connection between your degree field and the Claims Analyst role. A finance or data analytics degree maps cleanly. A general studies degree needs supporting course transcripts and a credential evaluation to strengthen the specialty occupation argument.
Target payers with LCA filing history
Search Migrate Mate's employer database to identify insurance carriers and third-party administrators with verified H-1B LCA filings for claims roles. DOL Labor Condition Application data shows which employers have actively sponsored this job title, not just posted it.
Check prevailing wage before negotiating offers
Your employer's LCA must certify a wage at or above the DOL prevailing wage for your work location and SOC code. Use the OFLC Wage Search to look up Level I through Level IV wages for Claims Analysts in your metro area before any salary discussion.
Understand the cap-gap risk for OPT holders
If your OPT expires before October 1 and your H-1B petition is selected, cap-gap protection extends your work authorization automatically. Confirm your employer will file before April 1 so your authorization doesn't lapse between OPT end and the new fiscal year.
Verify E-Verify enrollment before accepting an offer
Employers sponsoring H-1B workers must use E-Verify to confirm work authorization. If a claims department operates as a subsidiary, confirm that the specific legal entity making the offer is enrolled, not just the parent company.
Request premium processing for tight start dates
Standard H-1B adjudication can run several months. If your start date is firm, ask your employer to file with premium processing through USCIS, which guarantees a decision within 15 business days and avoids limbo during claims team onboarding cycles.
H-1B Visa Claims Analyst: Frequently Asked Questions
Does a Claims Analyst role qualify as a specialty occupation for H-1B purposes?
Yes, if the position requires at least a bachelor's degree in a specific field such as finance, business administration, health information management, or data analytics. The key is that the degree must be a normal requirement for the role, not just preferred. Employers strengthen the case by citing industry standards and internal job descriptions that tie the role to a specific field of study.
Which employers sponsor H-1B visas for Claims Analyst positions?
Insurance carriers, managed care organizations, third-party administrators, and large healthcare systems are the most consistent sponsors. Employers in these sectors file LCAs with the DOL each time they hire an H-1B worker, creating a public record of sponsorship activity. Migrate Mate lets you filter employers by occupation and visa filing history so you're targeting companies with a real track record, not just open postings.
What SOC code applies to Claims Analyst roles for H-1B filings?
Claims Analysts are typically classified under SOC 13-1031 (Claims Adjusters, Examiners, and Investigators) or 13-2099 (Financial Specialists, All Other), depending on the specific duties involved. The SOC code your employer selects determines the prevailing wage tier your LCA must meet. You can verify which classification fits your job description by reviewing the O*NET occupation profiles for both codes.
Can a Claims Analyst position support H-1B sponsorship at a small insurance firm?
Yes. There's no employer size requirement for H-1B sponsorship. A small firm can file an H-1B petition as long as it can demonstrate a legitimate employer-employee relationship, pay at least the DOL prevailing wage, and show the role genuinely requires a specialized degree. Smaller firms sometimes face closer scrutiny on specialty occupation, so a well-documented job description matters more at this scale.
How does the H-1B annual lottery affect timelines for Claims Analyst job seekers?
USCIS accepts H-1B registrations each March for the fiscal year starting October 1. If selected, your employer files the full petition by June. That means a Claims Analyst starting a job search in late summer for the following year is already behind the cycle. Targeting employers during the prior fall gives you enough runway to receive an offer, complete the LCA process, and register before the March window closes.