Claims Analyst Jobs in USA with Visa Sponsorship
Claims analysts examine insurance claims, investigate coverage details, and determine settlement amounts. Most positions require a bachelor's degree in business, finance, or related field, making them eligible for H-1B visa and other professional visas when employers can demonstrate the specialized knowledge requirement. For detailed occupation requirements, see the O*NET profile.
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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 155+ Claims Analyst Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Claims Analyst roles.
Get Access To All JobsTips for Finding Visa Sponsorship as a Claims Analyst
Target larger insurance companies and TPAs
Major insurers like Allstate, Progressive, and Liberty Mutual regularly sponsor visas. Third-party administrators handling claims for multiple carriers also frequently need international talent with specialized analytical skills.
Emphasize your analytical and investigative background
Claims analysis requires specialized training in fraud detection, medical terminology, and regulatory compliance. Highlight coursework, certifications, or experience that demonstrates these technical skills beyond general business knowledge.
Consider specialized claims areas
Property, casualty, workers' compensation, and medical claims each require distinct expertise. Specializing in complex areas like subrogation or catastrophic claims strengthens your case for visa sponsorship.
Get relevant insurance certifications
Professional designations like AIC (Associate in Claims) or CPCU (Chartered Property Casualty Underwriter) demonstrate specialized knowledge that supports H-1B specialty occupation requirements and makes you more attractive to sponsors.
Apply to companies with established programs
Insurance companies with existing visa sponsorship programs understand the process better. Check DOL disclosure data to identify employers who have successfully sponsored claims analysts or similar analytical roles recently.
Highlight multilingual abilities
Claims analysts often handle cases involving non-English speakers or international coverage. Fluency in Spanish, Mandarin, or other languages can differentiate you and justify specialized skills for sponsorship purposes.
Frequently Asked Questions
What degree do I need for claims analyst visa sponsorship?
Most claims analyst positions require a bachelor's degree in business administration, finance, economics, or a related field. Some employers accept degrees in mathematics, statistics, or criminal justice if the role involves fraud investigation. The degree requirement must be specific to support H-1B visa specialty occupation criteria.
Do claims analyst roles qualify for H-1B specialty occupation status?
Claims analyst positions can qualify for H-1B if the employer demonstrates that the role requires specialized knowledge and a specific bachelor's degree. Complex claims involving litigation support, medical analysis, or regulatory compliance are more likely to meet specialty occupation requirements than basic claims processing.
Which insurance companies sponsor visas for claims analysts?
Major insurance carriers like State Farm, GEICO, Travelers, and AIG have sponsored visas for analytical roles. Large third-party administrators and claims management companies also sponsor international candidates. Check recent DOL LCA filings to identify employers actively sponsoring similar positions.
What's the approval rate for claims analyst H-1B petitions?
H-1B approval rates for business analyst roles (which includes claims analysts) have ranged from 75-85% in recent years. Success depends on how well the employer demonstrates that the specific position requires specialized knowledge beyond general business analysis skills.
Can I transfer my visa if I change insurance companies?
Yes, you can transfer your H-1B to a new insurance company, but the new employer must file a new I-129 petition. You can start working once the transfer petition is filed if you maintain valid status. The new role must also meet specialty occupation requirements.
How to find Claims Analyst jobs with visa sponsorship?
To find Claims Analyst jobs with visa sponsorship, use Migrate Mate, which specializes in connecting international candidates with sponsoring employers. Focus your search on insurance companies, healthcare organizations, and large corporations that frequently sponsor H-1B and other work visas for analytical roles. These employers often need skilled professionals to assess insurance claims, analyze data patterns, and investigate potential fraud.
What is the prevailing wage requirement for sponsored Claims Analyst jobs?
U.S. employers sponsoring a visa must pay at least the prevailing wage, which is what workers in the same role, area, and experience level typically earn. The Department of Labor sets this rate to make sure companies aren't hiring foreign workers simply because they'd accept lower pay than a U.S. worker. It varies by job title, location, and experience. You can look up current prevailing wage rates for any occupation and location using the OFLC Wage Search page.