OPT Medical Claims Examiner Jobs
Medical Claims Examiner roles fall under healthcare administration, a field where many employers hire on OPT. Your 12-month standard OPT window is enough to demonstrate value, and a STEM extension may apply if your degree is in health informatics or a related qualifying field. Attention to compliance and billing accuracy transfers directly into this role.
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Get Access To All JobsBy joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claims Examiner - Workers Compensation | CA Jurisdiction
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
- Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
- Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
- Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
- Enjoy flexibility and autonomy in your daily work, your location, and your career path.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We're looking for a claims professional with California workers' compensation experience who enjoys solving complex problems and delivering outstanding service. The ideal candidate has experience handling litigated and high-exposure claims, understands California jurisdictional requirements, and can confidently manage claims through investigation, benefit determination, settlement negotiation, and resolution.
PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult California workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
- Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
QUALIFICATIONS
Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience: Four (4) years of California workers compensation claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.
TAKING CARE OF YOU
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
WORK ENVIRONMENT REQUIREMENTS INCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical: Computer keyboarding.
Auditory/Visual: Hearing, vision and talking.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $100,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Claims #ClaimsExaminer #LI-Remote
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
By joining Sedgwick, you'll be part of something truly meaningful. It’s what our 33,000 colleagues do every day for people around the world who are facing the unexpected. We invite you to grow your career with us, experience our caring culture, and enjoy work-life balance. Here, there’s no limit to what you can achieve.
Newsweek Recognizes Sedgwick as America’s Greatest Workplaces National Top Companies
Certified as a Great Place to Work®
Fortune Best Workplaces in Financial Services & Insurance
Claims Examiner - Workers Compensation | CA Jurisdiction
Are you looking for an opportunity to join a global industry leader where you can bring your big ideas to help solve problems for some of the world’s best brands?
- Apply your knowledge and experience to adjudicate complex customer claims in the context of an energetic culture.
- Deliver innovative customer-facing solutions to clients who represent virtually every industry and comprise some of the world’s most respected organizations.
- Be a part of a rapidly growing, industry-leading global company known for its excellence and customer service.
- Leverage Sedgwick’s broad, global network of experts to both learn from and to share your insights.
- Take advantage of a variety of professional development opportunities that help you perform your best work and grow your career.
- Enjoy flexibility and autonomy in your daily work, your location, and your career path.
- Access diverse and comprehensive benefits to take care of your mental, physical, financial and professional needs.
ARE YOU AN IDEAL CANDIDATE? We're looking for a claims professional with California workers' compensation experience who enjoys solving complex problems and delivering outstanding service. The ideal candidate has experience handling litigated and high-exposure claims, understands California jurisdictional requirements, and can confidently manage claims through investigation, benefit determination, settlement negotiation, and resolution.
PRIMARY PURPOSE OF THE ROLE To analyze complex or technically difficult California workers' compensation claims to determine benefits due; to work with high exposure claims involving litigation and rehabilitation; to ensure ongoing adjudication of claims within service expectations, industry best practices and specific client service requirements; and to identify subrogation of claims and negotiate settlements.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
- Analyzes and processes complex or technically difficult workers' compensation claims by investigating and gathering information to determine the exposure on the claim; manages claims through well-developed action plans to an appropriate and timely resolution.
- Negotiates settlement of claims within designated authority.
- Calculates and assigns timely and appropriate reserves to claims; manages reserve adequacy throughout the life of the claim.
- Calculates and pays benefits due; approves and makes timely claim payments and adjustments; and settles claims within designated authority level.
- Prepares necessary state fillings within statutory limits.
- Manages the litigation process; ensures timely and cost effective claims resolution.
- Reporting claims to the excess carrier and responding to requests of directions in a professional and timely manner.
QUALIFICATIONS
Education & Licensing: Bachelor's degree from an accredited college or university preferred. Professional certification as applicable to line of business preferred.
Experience: Four (4) years of California workers compensation claims management experience or equivalent combination of education and experience required.
Licensing / Jurisdiction Knowledge: California jurisdictional knowledge required; SIP required or must be obtained within one year of hire date.
TAKING CARE OF YOU
- Flexible work schedule.
- Referral incentive program.
- Career development and promotional growth opportunities.
- A diverse and comprehensive benefits offering including medical, dental vision, 401K on day one.
WORK ENVIRONMENT REQUIREMENTS INCLUDE
When applicable and appropriate, consideration will be given to reasonable accommodations.
Mental: Clear and conceptual thinking ability; excellent judgment, troubleshooting, problem solving, analysis, and discretion; ability to handle work-related stress; ability to handle multiple priorities simultaneously; and ability to meet deadlines.
Physical: Computer keyboarding.
Auditory/Visual: Hearing, vision and talking.
As required by law, Sedgwick provides a reasonable range of compensation for roles that may be hired in jurisdictions requiring pay transparency in job postings. Actual compensation is influenced by a wide range of factors including but not limited to skill set, level of experience, and cost of specific location. For the jurisdiction noted in this job posting only, the range of starting pay for this role is $80,000 - $100,000. A comprehensive benefits package is offered including but not limited to, medical, dental, vision, 401k and matching, PTO, disability and life insurance, employee assistance, flexible spending or health savings account, and other additional voluntary benefits.
Claims #ClaimsExaminer #LI-Remote
Qualified applicants with arrest or conviction records will be considered for employment in accordance with the Los Angeles County Fair Chance Ordinance for Employers, the City of Los Angeles’ Fair Chance Initiative for Hiring Ordinance, the San Diego Fair Chance Ordinance, the San Francisco Fair Chance Ordinance, the California Fair Chance Act, and all other applicable laws.
Sedgwick is an Equal Opportunity Employer and a Drug-Free Workplace.
If you're excited about this role but your experience doesn't align perfectly with every qualification in the job description, consider applying for it anyway! Sedgwick is building a diverse, equitable, and inclusive workplace and recognizes that each person possesses a unique combination of skills, knowledge, and experience. You may be just the right candidate for this or other roles.
See all OPT Medical Claims Examiner Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new OPT Medical Claims Examiner Jobs.
Get Access To All JobsTips for Finding OPT Sponsorship in Medical Claims Examiner
Highlight your healthcare billing knowledge upfront
Employers screening OPT candidates want proof you can contribute immediately. Lead your resume with specific systems you know, such as ICD-10 coding, CPT codes, or claims processing software. Concrete technical skills reduce perceived hiring risk for OPT applicants.
Target mid-size insurers and third-party administrators
Large national insurers often have rigid hiring pipelines, but mid-size TPAs and regional health plans hire more flexibly. These employers process high claim volumes and need trained examiners quickly, making them more receptive to sponsoring or extending OPT candidates.
Confirm your OPT end date before applying
Medical claims roles often have onboarding timelines of four to six weeks. If your OPT expires within 90 days of an offer, flag this early. Employers need time to evaluate H-1B visa sponsorship options before your authorization lapses mid-employment.
Frame STEM OPT eligibility if your degree qualifies
Degrees in health informatics, healthcare analytics, or biomedical informatics may qualify for the 24-month STEM extension. Employers who hesitate over a 12-month window often reconsider when they learn you can remain authorized for three years total.
Emphasize accuracy and compliance in interviews
Claims examiners handle adjudication decisions with real financial and legal consequences. Interviewers want to see that you understand HIPAA, fraud detection protocols, and denial logic. Connecting your academic background to regulatory compliance builds credibility quickly.
Get your EAD card details ready before offers move fast
Some healthcare employers finalize OPT hires within days of an interview. Have your EAD card, I-20 with OPT authorization, and DSO contact information organized before you start applying. Delays in producing documents can stall or lose an offer.
Medical Claims Examiner OPT: Frequently Asked Questions
Does a Medical Claims Examiner role qualify for OPT work authorization?
Yes, Medical Claims Examiner positions qualify for OPT as long as the work is directly related to your field of study. Degrees in health information management, healthcare administration, business, or a related field typically satisfy this requirement. You should confirm the connection with your DSO before accepting an offer to ensure your employment is properly reported in SEVIS.
Can I work as a Medical Claims Examiner remotely on OPT?
Remote work is permitted on OPT, but your DSO must report your employer's address in SEVIS, not your home address. If your employer is fully remote and has no fixed location, your DSO will typically use your home address as the work site. Keep your DSO updated if your work arrangement or employer address changes at any point during your OPT period.
Does a Medical Claims Examiner job qualify for the STEM OPT extension?
The job title itself does not determine STEM OPT eligibility. What matters is whether your degree is on the DHS STEM Designated Degree Program list. Degrees in health informatics, biomedical informatics, or healthcare analytics may qualify. If your degree qualifies, your employer must also be enrolled in E-Verify and sign a formal training plan with you before USCIS approves the extension.
How do I find Medical Claims Examiner jobs that are open to OPT students?
Many employers do not advertise OPT-friendliness in job postings, so filtering by sponsorship openness saves significant time. Migrate Mate is built specifically for this, letting you browse Medical Claims Examiner roles from employers who have hired international candidates before. Searching there narrows your list to opportunities where OPT work authorization is far less likely to be an immediate disqualifier.
What happens to my OPT status if my employer terminates my Medical Claims Examiner role?
If your employment ends before your OPT expires, you have a 60-day grace period to find a new qualifying job, transfer to a different visa status, or depart the United States. You must report the separation to your DSO promptly. Accumulating more than 90 days of unemployment during your OPT period violates the terms of your work authorization, so acting quickly matters.