OPT Claims Resolution Specialist Jobs
Claims Resolution Specialist roles involve investigating, analyzing, and resolving insurance or billing disputes, making them a strong fit for OPT students with analytical or healthcare administration backgrounds. Your 12-month OPT window (or 24-month STEM extension if your degree qualifies) gives you meaningful time to build experience in a field where many employers actively hire international graduates.
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Manages, investigates and resolves medical claims assigned by the Claims Team Manager and assists in providing service to policyholders and agents under general supervision. May perform field investigation on assigned cases and make recommendations on additional work as indicated. Recognizes and solves problems of moderate scope and complexity.
Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory.
NJ No Fault experience is required.
Responsibilities:
- Manages, evaluates and resolves claims assigned by Claims Team Manager. Evaluates liability, medical necessity, causality and settles claims within prescribed authority.
- Communicates with policyholders, agents, witnesses, and claimants in order to gather information regarding claims and refers tasks to auxiliary resources as necessary. Responds to various written and telephone inquiries including status reports.
- Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim.
- Ensures adequacy of reserves and settlement authority.
- Confirms or denies coverage and liability and advises policyholders, agents and claimants as to proper course of action.
- Makes effective use of loss management techniques (IMEs, Nurse Review, and Bill Review). Negotiates settlements with attorneys, claimants, and medical providers. Arranges for expert inspections involving third party or potential fraud actions as needed.
- Updates files and provides comprehensive reports as required.
- Identifies and recommends referral of potentially fraudulent claims to the Special Investigation Unit.
- Recognizes continuous improvement opportunities and develops.
Qualifications
- Strong written and oral communications skills required. Good interpersonal, analytical, decision making, and negotiation skills required.
- Customer service experience preferred.
- Knowledge of legal liability, general insurance policy coverage and the ability to review and understand medical records to determine causality and medical necessity.
- The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and 6-12 months of directly related experience.
- Ability to obtain proper licensing as required.
About us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
- California
- Los Angeles Incorporated
- Los Angeles Unincorporated
- Philadelphia
- San Francisco
Description
Manages, investigates and resolves medical claims assigned by the Claims Team Manager and assists in providing service to policyholders and agents under general supervision. May perform field investigation on assigned cases and make recommendations on additional work as indicated. Recognizes and solves problems of moderate scope and complexity.
Training is a critical component to your success and that success starts with reliable attendance. Attendance and active engagement during training is mandatory.
NJ No Fault experience is required.
Responsibilities:
- Manages, evaluates and resolves claims assigned by Claims Team Manager. Evaluates liability, medical necessity, causality and settles claims within prescribed authority.
- Communicates with policyholders, agents, witnesses, and claimants in order to gather information regarding claims and refers tasks to auxiliary resources as necessary. Responds to various written and telephone inquiries including status reports.
- Reviews medical records and bills to verify claimed treatment is causally related to the accident and is reasonable and necessary given facts of the claim.
- Ensures adequacy of reserves and settlement authority.
- Confirms or denies coverage and liability and advises policyholders, agents and claimants as to proper course of action.
- Makes effective use of loss management techniques (IMEs, Nurse Review, and Bill Review). Negotiates settlements with attorneys, claimants, and medical providers. Arranges for expert inspections involving third party or potential fraud actions as needed.
- Updates files and provides comprehensive reports as required.
- Identifies and recommends referral of potentially fraudulent claims to the Special Investigation Unit.
- Recognizes continuous improvement opportunities and develops.
Qualifications
- Strong written and oral communications skills required. Good interpersonal, analytical, decision making, and negotiation skills required.
- Customer service experience preferred.
- Knowledge of legal liability, general insurance policy coverage and the ability to review and understand medical records to determine causality and medical necessity.
- The capabilities, skills and knowledge required is normally acquired through a Bachelor’s degree or equivalent experience and 6-12 months of directly related experience.
- Ability to obtain proper licensing as required.
About us
Pay Philosophy: The typical starting salary range for this role is determined by a number of factors including skills, experience, education, certifications and location. The full salary range for this role reflects the competitive labor market value for all employees in these positions across the national market and provides an opportunity to progress as employees grow and develop within the role. Some roles at Liberty Mutual have a corresponding compensation plan which may include commission and/or bonus earnings at rates that vary based on multiple factors set forth in the compensation plan for the role.
At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. This comes to life through comprehensive benefits, workplace flexibility, professional development opportunities, and a host of opportunities provided through our Employee Resource Groups. Each employee plays a role in creating our inclusive culture, which supports every individual to do their best work. Together, we cultivate a community where everyone can make a meaningful impact for our business, our customers, and the communities we serve.
We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being. To learn more about our benefit offerings please visit: https://www.libertymutualgroup.com/about-lm/careers/benefits
Liberty Mutual is an equal opportunity employer. We will not tolerate discrimination on the basis of race, color, national origin, sex, sexual orientation, gender identity, religion, age, disability, veteran's status, pregnancy, genetic information or on any basis prohibited by federal, state or local law.
Fair Chance Notices
- California
- Los Angeles Incorporated
- Los Angeles Unincorporated
- Philadelphia
- San Francisco
See all OPT Claims Resolution Specialist Jobs
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Get Access To All JobsTips for Finding OPT Sponsorship as a Claims Resolution Specialist
Target employers with established HR infrastructure
Large insurers, hospital systems, and third-party administrators process claims at scale and have HR teams experienced with OPT work authorization. Smaller billing companies may not have dealt with it before, which adds friction to the hiring process.
Highlight your STEM extension eligibility upfront
If your degree is in health informatics, data analytics, or a qualifying STEM field, mention your 24-month extension eligibility in your cover letter. It meaningfully extends your authorized work period and makes sponsorship conversations more practical for employers.
Frame your analytical skills in claims-specific language
Employers want candidates who can interpret Explanation of Benefits documents, identify billing discrepancies, and apply payer-specific rules. Translate coursework or internship experience into this terminology rather than describing general data or research skills.
Research employers who file H-1B petitions in your field
Claims resolution roles exist across healthcare systems, insurance carriers, and revenue cycle management firms. Employers who have previously sponsored H-1B visa workers in similar roles are more likely to be open to OPT hiring and eventual visa sponsorship discussions.
Obtain a relevant certification before applying
Credentials like the Certified Professional Coder (CPC) or Certified Revenue Cycle Professional (CRCP) signal technical competency to hiring managers. They also demonstrate commitment to the field, which can differentiate you from other entry-level candidates on OPT.
Address OPT authorization clearly and confidently in interviews
Many hiring managers are unfamiliar with F-1 OPT. Prepare a one-paragraph explanation covering your authorization period, STEM extension eligibility if applicable, and what the employer needs to do, which is simply verify your EAD card.
Claims Resolution Specialist OPT: Frequently Asked Questions
Do Claims Resolution Specialist roles typically sponsor OPT students for H-1B visas?
Sponsorship varies significantly by employer. Large hospital networks, national insurers, and revenue cycle management firms like Cotiviti or Optum have sponsored H-1B workers in claims-adjacent roles and are more likely to consider OPT candidates with a path to sponsorship. Smaller billing offices rarely have the infrastructure for it. Filtering by employer size and prior H-1B history is the most reliable way to identify sponsorship-friendly opportunities.
Does a Claims Resolution Specialist role qualify for the 24-month STEM OPT extension?
It depends on your degree, not your job title. If your F-1 program was in health informatics, healthcare data analytics, computer science, or another STEM-designated field, you may qualify for the 24-month STEM extension regardless of your job title. The role itself must also involve direct application of your STEM knowledge. Work with your DSO to confirm your degree qualifies before relying on the extension in job applications.
What documents do I need to present when starting a Claims Resolution Specialist job on OPT?
You'll present your Employment Authorization Document (EAD) card and passport during the I-9 verification process on or before your first day. Your employer cannot require you to produce other immigration documents beyond what the I-9 form permits. Keep a copy of your OPT approval notice separately in case questions arise about your authorized period or employer reporting requirements under STEM OPT.
Can I work for a healthcare staffing agency as a Claims Resolution Specialist on OPT?
Yes, but the agency must be your employer of record for OPT purposes. You cannot work as an independent contractor on standard OPT. If you're on STEM OPT, your employer must also be enrolled in E-Verify, which most established staffing agencies are. Confirm E-Verify enrollment before accepting an offer, since working for a non-enrolled employer on STEM OPT can jeopardize your status.
Where can I find Claims Resolution Specialist jobs that are open to OPT candidates?
Migrate Mate is built specifically for F-1 OPT and international students, so the job listings are filtered for visa-friendliness rather than requiring you to screen hundreds of postings manually. Claims resolution roles appear across healthcare, insurance, and revenue cycle categories. Searching Migrate Mate by role type lets you identify which employers have experience working with OPT students before you apply.