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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Get Access To All JobsAs a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
Remote Work - New York, Albany, New York, United States of America, 12224
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
910402 United Business Office
Work Shift:
UR - Day (United States of America)
Range:
UR URCA 205 H
Compensation Range:
$20.30 - $27.41
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management.
ESSENTIAL FUNCTIONS
With general direction of the Manager/Supervisor/Lead:
- Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services.
- Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims, identify problems, and takes appropriate action to assure claim resolution.
- Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies.
- Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution.
- Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate.
- May perform other duties as assigned.
MINIMUM EDUCATION & EXPERIENCE
- Associate's degree and 2 years of relevant experience required
- Or equivalent combination of education and experience
KNOWLEDGE, SKILLS AND ABILITIES
- Excellent problem-solving skills preferred
- Excellent communication skills preferred
- Excellent customer service skills preferred
- Strong working knowledge of the professional billing software applications preferred
- Ability to type 25 wpm preferred.
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.
As a community, the University of Rochester is defined by a deep commitment to Meliora - Ever Better. Embedded in that ideal are the values we share: equity, leadership, integrity, openness, respect, and accountability. Together, we will set the highest standards for how we treat each other to ensure our community is welcoming to all and is a place where all can thrive.
Job Location (Full Address):
Remote Work - New York, Albany, New York, United States of America, 12224
Opening:
Worker Subtype:
Regular
Time Type:
Full time
Scheduled Weekly Hours:
40
Department:
910402 United Business Office
Work Shift:
UR - Day (United States of America)
Range:
UR URCA 205 H
Compensation Range:
$20.30 - $27.41
The referenced pay range represents the minimum and maximum compensation for this job. Individual annual salaries/hourly rates will be set within the job's compensation range, and will be determined by considering factors including, but not limited to, market data, education, experience, qualifications, expertise of the individual, and internal equity considerations.
Responsibilities:
The Claims Resolution Representative III is responsible for working across the professional fee organization, handling follow-up activities designed to bring all open accounts receivable to successful closure. Responsible for effective claims follow-up on complex, multi-faceted accounts to obtain maximum revenue collection and closure. Responsibilities include, but are not limited to, independent research, claim correction and resubmission, handling payer specific appeal process taking timely and routine action to resolve unpaid claims. The Claims Resolution Representative III reports to Accounts Receivable Management.
ESSENTIAL FUNCTIONS
With general direction of the Manager/Supervisor/Lead:
- Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable, making any corrections in the professional billing system necessary to ensure balance resolution for all assigned URMFG physician services.
- Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections received thru daily electronic and claims submission, etc. Research claims, identify problems, and takes appropriate action to assure claim resolution.
- Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner. Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing. Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims. Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies.
- Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding. Escalates system issues preventing claims submission and follow-up for review and resolution.
- Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate.
- May perform other duties as assigned.
MINIMUM EDUCATION & EXPERIENCE
- Associate's degree and 2 years of relevant experience required
- Or equivalent combination of education and experience
KNOWLEDGE, SKILLS AND ABILITIES
- Excellent problem-solving skills preferred
- Excellent communication skills preferred
- Excellent customer service skills preferred
- Strong working knowledge of the professional billing software applications preferred
- Ability to type 25 wpm preferred.
The University of Rochester is committed to fostering, cultivating, and preserving an inclusive and welcoming culture to advance the University’s Mission to Learn, Discover, Heal, Create – and Make the World Ever Better. In support of our values and those of our society, the University is committed to not discriminating on the basis of age, color, disability, ethnicity, gender identity or expression, genetic information, marital status, military/veteran status, national origin, race, religion, creed, sex, sexual orientation, citizenship status, or any other characteristic protected by federal, state, or local law (Protected Characteristics). This commitment extends to non-discrimination in the administration of our policies, admissions, employment, access, and recruitment of candidates, for all persons consistent with our values and based on applicable law.
See all OPT Claims Resolution Specialist Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new OPT Claims Resolution Specialist Jobs.
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.