Claims Specialist Jobs in USA with Visa Sponsorship
Claims specialists process insurance claims, investigate fraud, and assess coverage disputes for insurance companies, healthcare organizations, and third-party administrators. Most positions qualify for H-1B visa sponsorship when they require specialized knowledge in actuarial science, risk management, or healthcare administration, though entry-level claims processing roles may not meet specialty occupation requirements. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsINTRODUCTION
UPMC Health Plan and WorkPartners is hiring a full-time Medical Only Claims Specialist I to join the Workers Comp Claims team. This entry level role will work Monday - Friday daylight hours EST and may work remotely.
Employees living within 50 miles of our downtown Pittsburgh office are required to work on-site roughly once per month. For those residing outside this 50-mile radius, this is optional.
The UPMC WorkPartners Workers' Compensation Medical Only Claims Specialist 1 reports to the Workers' Compensation Supervisor. This is an entry level position within the Workers' Compensation Claims Department. The Medical Only Claims Specialist 1 is responsible for coverage analysis, investigation, evaluation, communication, and disposition of assigned medical claims within the WorkPartners Workers' Compensation business unit. The Medical Only Claims Specialist 1 will ensure claims are processed within company policies, procedures, and within individual's prescribed authority following established best practices and performance standards.
Responsibilities:
- Manage non-complex and non-problematic medical-only and restricted medical only claims under close supervision.
- Additional duties as required. Appropriate state licensing to be secured as needed. Excellent communication skills.
- Adhere to client and carrier guidelines and special handling requests.
- Communicate claim status with the injured worker, insured/employer, and broker as needed.
- Prepare and present for insured/employer claim reviews outlining claims status and action plans with oversight from supervisor.
- Receives claim, confirms policy coverage and acknowledgement of the claim.
- Evaluate claim, calculate and establish appropriate reserves and review on a regular basis to ensure adequacy for exposure under close supervision.
- Establish reserves and authorize payments within authority limits.
- Investigate the claims through telephone, written correspondence, and/or personal contact with injured workers, insureds/employer witnesses and others having pertinent information.
- Review invoices and medical records to determine eligibility for payment or denial.
- Determine validity and compensability of the claim.
- Participate in periodic claim reviews as needed.
- Participate in monthly account renewal meetings as needed.
BASIC QUALIFICATIONS
- Bachelors and/or advanced degree or a minimum of 1 year of administrative, claims, and/or customer service experience, preferably in Workers Compensation.
- Prior experience working in an office-based role strongly preferred.
- Demonstrated verbal and written communications skills.
- Demonstrated analytical and decision-making skills.
- Appropriate state licensing to be secured as needed. Excellent communication skills.
LICENSURE, CERTIFICATIONS, AND CLEARANCES:
UPMC is an Equal Opportunity Employer/Disability/Veteran
INTRODUCTION
UPMC Health Plan and WorkPartners is hiring a full-time Medical Only Claims Specialist I to join the Workers Comp Claims team. This entry level role will work Monday - Friday daylight hours EST and may work remotely.
Employees living within 50 miles of our downtown Pittsburgh office are required to work on-site roughly once per month. For those residing outside this 50-mile radius, this is optional.
The UPMC WorkPartners Workers' Compensation Medical Only Claims Specialist 1 reports to the Workers' Compensation Supervisor. This is an entry level position within the Workers' Compensation Claims Department. The Medical Only Claims Specialist 1 is responsible for coverage analysis, investigation, evaluation, communication, and disposition of assigned medical claims within the WorkPartners Workers' Compensation business unit. The Medical Only Claims Specialist 1 will ensure claims are processed within company policies, procedures, and within individual's prescribed authority following established best practices and performance standards.
Responsibilities:
- Manage non-complex and non-problematic medical-only and restricted medical only claims under close supervision.
- Additional duties as required. Appropriate state licensing to be secured as needed. Excellent communication skills.
- Adhere to client and carrier guidelines and special handling requests.
- Communicate claim status with the injured worker, insured/employer, and broker as needed.
- Prepare and present for insured/employer claim reviews outlining claims status and action plans with oversight from supervisor.
- Receives claim, confirms policy coverage and acknowledgement of the claim.
- Evaluate claim, calculate and establish appropriate reserves and review on a regular basis to ensure adequacy for exposure under close supervision.
- Establish reserves and authorize payments within authority limits.
- Investigate the claims through telephone, written correspondence, and/or personal contact with injured workers, insureds/employer witnesses and others having pertinent information.
- Review invoices and medical records to determine eligibility for payment or denial.
- Determine validity and compensability of the claim.
- Participate in periodic claim reviews as needed.
- Participate in monthly account renewal meetings as needed.
BASIC QUALIFICATIONS
- Bachelors and/or advanced degree or a minimum of 1 year of administrative, claims, and/or customer service experience, preferably in Workers Compensation.
- Prior experience working in an office-based role strongly preferred.
- Demonstrated verbal and written communications skills.
- Demonstrated analytical and decision-making skills.
- Appropriate state licensing to be secured as needed. Excellent communication skills.
LICENSURE, CERTIFICATIONS, AND CLEARANCES:
UPMC is an Equal Opportunity Employer/Disability/Veteran
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Get Access To All JobsTips for Finding Visa Sponsorship as a Claims Specialist
Target roles requiring specialized expertise
Focus on senior claims specialist, fraud investigator, or complex claims analyst positions. These roles typically require specialized knowledge in insurance law, medical terminology, or actuarial principles that qualify for H-1B sponsorship.
Highlight relevant degree connections
Connect your finance, business administration, or risk management degree directly to claims analysis duties. Emphasize coursework in statistics, healthcare administration, or insurance principles that supports specialty occupation requirements.
Emphasize analytical and investigative skills
Showcase experience with claims software, fraud detection systems, or data analysis tools. Document complex cases you've handled that required specialized judgment beyond routine claims processing to strengthen visa petition.
Consider healthcare-focused positions
Medical claims specialists often have stronger H-1B cases due to specialized knowledge requirements in medical coding, HIPAA compliance, and healthcare regulations. These roles typically require specific educational backgrounds in health administration.
Research company sponsorship history
Large insurance companies like State Farm, Allstate, and Progressive have sponsored H-1B workers for claims roles. Check DOL disclosure data to identify employers with successful sponsorship records for similar positions.
Prepare for specialty occupation documentation
Gather evidence showing your role requires specialized knowledge beyond basic claims processing. Include job descriptions emphasizing complex analysis, regulatory compliance, or technical expertise that supports H-1B specialty occupation requirements.
Frequently Asked Questions
Do claims specialist positions qualify for H-1B sponsorship?
Senior claims specialist roles typically qualify for H-1B visa sponsorship when they require specialized knowledge in insurance law, actuarial science, or complex fraud investigation. Entry-level claims processing positions that primarily involve routine data entry and basic coverage verification often don't meet specialty occupation requirements. Focus on roles emphasizing analytical expertise and specialized industry knowledge.
How to find Claims Specialist jobs with visa sponsorship?
To find Claims Specialist positions with visa sponsorship, use Migrate Mate, which specializes in connecting international talent with sponsoring employers. Focus your search on insurance companies, healthcare organizations, and large corporations that frequently sponsor H-1B, TN visa, and O-1 visas for specialized claims professionals. These employers often need skilled specialists to handle complex claims processing and risk assessment roles.
What degree do I need for claims specialist visa sponsorship?
Most sponsored claims specialist positions require a bachelor's degree in business administration, finance, economics, or risk management. Healthcare claims roles may prefer degrees in health administration or healthcare management. The key is connecting your educational background to the specialized knowledge required for complex claims analysis and regulatory compliance in your target role.
Which insurance companies sponsor H-1B workers for claims roles?
Major insurers including Progressive, State Farm, Allstate, and Aetna have sponsored H-1B workers for claims specialist positions. Large third-party administrators and healthcare organizations also sponsor these roles. Check DOL LCA disclosure data to research specific companies' recent sponsorship activity and identify the most promising employers for your background.
How do medical claims specialist roles differ for visa purposes?
Medical claims specialist positions often have stronger H-1B cases because they require specialized knowledge of medical coding, HIPAA regulations, and healthcare reimbursement systems. These roles typically demand specific educational backgrounds in health administration or demonstrated expertise in complex medical claims processing that goes beyond routine administrative work.
What can disqualify a claims specialist role from H-1B sponsorship?
Positions focused primarily on data entry, basic document processing, or routine coverage verification may not qualify as specialty occupations. Job descriptions emphasizing clerical duties over analytical work, or roles that accept any bachelor's degree regardless of field, face higher denial risk. USCIS requires evidence that the position demands specialized knowledge specific to claims analysis or insurance expertise.
What is the prevailing wage requirement for sponsored Claims Specialist 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.