Claims Representative Jobs in USA with Visa Sponsorship
Claims Representative roles at U.S. insurance carriers and third-party administrators regularly appear on H-1B visa Labor Condition Applications, making them a viable path for sponsored candidates with degrees in business, finance, or a related field. Employers typically file through standard H-1B or TN visa channels depending on your nationality.
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Get Access To All JobsINTRODUCTION
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
ROLE AND RESPONSIBILITIES
Claims Representative, Auto | PIP | Remote | NY Lic
PRIMARY PURPOSE: To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Reviews claims to determine the nature of the medical loss and provides explanation of coverage.
- Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage.
- Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations.
- Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant.
- Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files.
- Ensures claim files are properly documented and correctly coded based on the policy.
- Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures.
- Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
- Negotiates resolution of claims and makes payments within authority.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.
Experience
Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience, nursing experience a plus.
Skills & Knowledge
- Knowledge of medical terminology and appropriate application of deductibles and limits
- Familiarity with Bodily Injury (BI)/Casualty adjusting
- Oral and written communication skills
- Detailed oriented
- PC literate, including Microsoft Office products
- Strong negotiation skills
- Good interpersonal and customer skills
- Good organization skills
- Good time management skills with the ability to multi-task
- Ability to work independently and in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
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, travel as required
Auditory/Visual: Hearing, vision and talking
COMPENSATION
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 $55,000-$60,000. 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.
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.
INTRODUCTION
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
ROLE AND RESPONSIBILITIES
Claims Representative, Auto | PIP | Remote | NY Lic
PRIMARY PURPOSE: To evaluate auto claims involving injured parties and manage first party medical treatment to determine eligibility under a personal injury protection and/or medical payment benefits.
ESSENTIAL FUNCTIONS AND RESPONSIBILITIES
- Reviews claims to determine the nature of the medical loss and provides explanation of coverage.
- Researches policy contract and interprets policy language to make coverage decisions based on 1st party medical coverage.
- Assesses medical treatment, evaluates medical bills, and initiates or reviews potential fraud investigations.
- Interprets medical records regarding injuries and addresses ongoing and continuous treatment for claimant.
- Identifies claim exposures and establishes reserves or adjust reserves accordingly on assigned files.
- Ensures claim files are properly documented and correctly coded based on the policy.
- Documents all claim activity and workflow accurately throughout the life of the claim in accordance with standard operating procedures.
- Provides effective and timely communication to client, claimants, medical providers, attorney offices, and vendors.
- Negotiates resolution of claims and makes payments within authority.
- Performs other duties as assigned.
- Supports the organization's quality program(s).
QUALIFICATIONS
Education & Licensing
Bachelor's degree from an accredited college or university preferred. State adjuster licenses required.
Experience
Three (3) years of Personal Injury Protection (PIP), medical payment and/or workers compensation or equivalent combination of education and experience, nursing experience a plus.
Skills & Knowledge
- Knowledge of medical terminology and appropriate application of deductibles and limits
- Familiarity with Bodily Injury (BI)/Casualty adjusting
- Oral and written communication skills
- Detailed oriented
- PC literate, including Microsoft Office products
- Strong negotiation skills
- Good interpersonal and customer skills
- Good organization skills
- Good time management skills with the ability to multi-task
- Ability to work independently and in a team environment
- Ability to meet or exceed Performance Competencies
WORK ENVIRONMENT
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, travel as required
Auditory/Visual: Hearing, vision and talking
COMPENSATION
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 $55,000-$60,000. 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.
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 145+ Claims Representative Jobs
Sign up for free to unlock all listings, filter by visa type, and get alerts for new Claims Representative roles.
Get Access To All JobsTips for Finding Claims Representative Jobs
Match your degree to the specialty occupation standard
Claims Representative roles qualify for H-1B sponsorship only when the position requires a specific bachelor's degree, not just any degree. Review the O*NET profile for this occupation to confirm how employers document the specialty occupation requirement on their LCA.
Target employers with active LCA filing history
Insurance carriers, managed care organizations, and third-party administrators file LCAs for Claims Representative roles more consistently than regional brokers. Use Migrate Mate to find employers with verified sponsorship history for this specific occupation before applying.
Verify prevailing wage tier before accepting an offer
Your employer must pay at least the DOL prevailing wage for your location and experience level. Run the OFLC Wage Search using the correct occupational category before negotiating, so you know whether an offer clears the minimum threshold USCIS will scrutinize.
Prepare a degree equivalency letter for three-year degrees
If you hold a three-year bachelor's degree from outside the U.S., your employer's immigration attorney may need a credential evaluation confirming U.S. equivalency. Request this from a NACES-member evaluator before your employer files the I-129 to avoid a Request for Evidence from USCIS.
Ask employers directly about cap-exempt filing options
Some claims roles at nonprofits affiliated with universities or research institutions qualify for cap-exempt H-1B petitions, bypassing the annual lottery entirely. During the offer process, ask the HR team whether the entity holds cap-exempt status before assuming lottery registration is required.
Get your PERM labor certification timeline in writing
If your employer plans to sponsor a green card after your H-1B is approved, confirm whether PERM labor certification is part of their standard process. DOL processing times for PERM applications can run over a year, so starting that conversation at the offer stage protects your long-term status.
Frequently Asked Questions
Do Claims Representative jobs qualify as a specialty occupation for H-1B purposes?
They can, but it depends on how the employer defines the role. USCIS requires that the position normally requires at least a bachelor's degree in a directly related field such as business administration, finance, or risk management. Generalist claims roles where any degree is accepted often fail this standard, so the job description wording matters significantly when the employer files the LCA and I-129.
Which visa types are realistic for a sponsored Claims Representative role?
H-1B is the most common path for this role. Canadian and Mexican nationals should also evaluate the TN visa under the USMCA, since Accountants and certain management consultants appear on the TN profession list and some claims roles may qualify under those categories depending on the position's requirements. Australian nationals can explore the E-3 visa, which carries no lottery and has never reached its annual cap.
How do I find employers who actively sponsor Claims Representative positions?
Migrate Mate lists U.S. employers with verified LCA sponsorship history for claims and insurance roles, searchable by city and job category. This lets you focus your applications on companies that have already committed to the sponsorship process rather than pitching the idea from scratch during interviews.
Does my insurance or claims certification count toward the specialty occupation requirement?
Professional certifications like the AIC or CPCU strengthen your profile but don't substitute for the degree requirement USCIS applies to specialty occupation determinations. The employer must demonstrate the position itself requires a specific bachelor's degree. Your certifications can support the argument that the role demands specialized knowledge, but the degree equivalency is the primary legal threshold.
Can a Claims Representative role support a green card through EB-2 or EB-3?
Yes, depending on your qualifications and how the employer categorizes the role. EB-3 skilled worker is the more common path, requiring at least two years of experience and a PERM labor certification filed with DOL. EB-2 is available if the position requires an advanced degree or if you can demonstrate exceptional ability. Country of birth affects wait times significantly due to per-country limits.
What is the prevailing wage requirement for sponsored Claims Representative 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.