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.
Find OPT Medical Claims Examiner JobsOverview
Showing 5 of 12+ Medical Claims Examiner jobs
See all 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 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, Auto | Bodily Injury
PRIMARY PURPOSE OF THE ROLE: To analyze and process complex bodily injury auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
ARE YOU AN IDEAL CANDIDATE?
To analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
- Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
- Responsible for litigation process on litigated claims.
- Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
- Reports large claims to excess carrier(s).
- Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
- Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
- Communicates claim action/processing with insured, client, and agent or broker when appropriate.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Skills: strong oral and written communication, including presentation skills, PC literate including Microsoft Office products, and ability to work in a team environment.
- Secure and maintain the State adjusting licenses as required for the position.
Work environment requirements include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
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 $70,000 per year. 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.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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, Auto | Bodily Injury
PRIMARY PURPOSE OF THE ROLE: To analyze and process complex bodily injury auto and commercial transportation claims by reviewing coverage, completing investigations, determining liability and evaluating the scope of damages.
ARE YOU AN IDEAL CANDIDATE?
To analyze complex auto bodily injury claims on behalf of our valued clients by evaluating coverage, investigating liability, and managing damages, while ensuring timely resolution within service expectations, industry best practices, and specific client requirements.
ESSENTIAL RESPONSIBILITIES MAY INCLUDE
- Processes complex auto commercial and personal line claims, including bodily injury and ensures claim files are properly documented and coded correctly.
- Responsible for litigation process on litigated claims.
- Coordinates vendor management, including the use of independent adjusters to assist the investigation of claims.
- Reports large claims to excess carrier(s).
- Develops and maintains action plans to ensure state required contact deadlines are met and to move the file towards prompt and appropriate resolution.
- Identifies and pursues subrogation and risk transfer opportunities; secures and disposes of salvage.
- Communicates claim action/processing with insured, client, and agent or broker when appropriate.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing: Five (5) years of claims management experience or equivalent combination of education and experience required to include in-depth knowledge of personal and commercial line auto policies, coverage’s, principles, and laws.
- Bachelor's degree from an accredited college or university preferred.
- Professional certification as applicable to line of business preferred.
- Skills: strong oral and written communication, including presentation skills, PC literate including Microsoft Office products, and ability to work in a team environment.
- Secure and maintain the State adjusting licenses as required for the position.
Work environment requirements include –
Physical: Computer keyboarding
Auditory/visual: Hearing, vision and talking
Mental: Clear and conceptual thinking ability; excellent judgement and discretion; ability to meet deadlines.
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 $70,000 per year. 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.
The statements contained in this document are intended to describe the general nature and level of work being performed by a colleague assigned to this description. They are not intended to constitute a comprehensive list of functions, duties, or local variances. Management retains the discretion to add or to change the duties of the position at any time.
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.