Medical Claims Examiner Jobs in USA with Visa Sponsorship
Medical claims examiners analyze insurance claims to determine coverage and payment decisions. This role qualifies for H-1B visa sponsorship when it requires specialized healthcare knowledge and a bachelor's degree in health administration, nursing, or related field. Employers value candidates with medical coding certification and claims processing experience. For detailed occupation requirements, see the O*NET profile.
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Get Access To All JobsPosition Summary: The Commercial Auto & General Liability Claims Examiner III independently manages a complex caseload of high-exposure California public entity commercial automobile and general liability claims, including litigated, catastrophic, and highly sensitive matters. The position is responsible for analyzing coverage, liability, damages, and legal issues; developing claim-resolution strategies; directing litigation and investigations; establishing appropriate reserves; and negotiating settlements within assigned authority.
This senior-level examiner serves as a technical resource to clients, management, and less-experienced claims professionals. The position maintains frequent contact with claimants, attorneys, defense counsel, experts, public agency representatives, and other parties involved. The Claims Examiner III provides clients with comprehensive recommendations regarding exposure, litigation strategy, reserves, settlement, and claim resolution. Position is remote/working from home.
DUTIES AND RESPONSIBILITIES:
- Independently investigate, analyze, evaluate, negotiate, and resolve complex, high-exposure commercial automobile and general liability claims.
- Manage litigated, catastrophic, sensitive, and technically complex California public entity claims from initial assignment through final resolution.
- Review and interpret policies, contracts, endorsements, coverage documents, client service instructions, and applicable laws to determine coverage and claim-handling obligations.
- Apply California public entity laws, statutes, immunities, defenses, procedures, and claims-presentation requirements to assigned matters.
- Identify and analyze complex issues involving liability, causation, damage, comparative negligence, immunities, indemnification, contribution, and risk transfer.
- Develop and implement comprehensive claim-action plans, litigation strategies, reserve recommendations, and settlement strategies.
- Establish and maintain timely, accurate, and well-supported reserves within assigned authority; promptly communicate significant exposure changes to the client and management.
- Evaluate settlement value and negotiate complex claims within delegated settlement authority.
- Prepare and present settlement recommendations for claims exceeding assigned authority.
- Direct and oversee defense counsel, investigators, appraisers, medical experts, engineers, accident-reconstruction specialists, and other outside service providers.
- Review and evaluate litigation plans, legal budgets, pleadings, discovery, expert reports, deposition testimony, and defense counsel recommendations.
- Monitor litigation progress, legal expenses, deadlines, and defense counsel performance to ensure matters are handled efficiently and in accordance with client expectations.
- Participate in mediations, mandatory settlement conferences, depositions, trials, and other legal proceedings when required.
- Conduct or coordinate field investigations and site inspections involving complex or high-exposure losses.
- Attend city council meetings, claim-review meetings, litigation strategy meetings, and client presentations in person when required.
- Prepare comprehensive loss reports addressing coverage, liability, damages, reserves, litigation strategy, settlement value, and recommended next steps.
- Present complex claim evaluations and recommendations clearly and professionally to clients, public agency representatives, management, and other stakeholders.
- Identify potential subrogation, contribution, contractual indemnity, additional insured, tender, or other risk-transfer opportunities and pursue recovery or transfer efforts at the client’s direction.
- Identify potential excess coverage, reinsurance, Medicare reporting, liens, statutory reporting, or other significant claim-related obligations and ensure timely escalation.
- Maintain complete, accurate, and timely claim-file documentation, including correspondence, evaluations, reports, negotiations, decisions, and action plans.
- Maintain an effective diary system and ensure that all claim activities, statutory deadlines, litigation dates, and client reporting requirements are completed timely.
- Communicate significant developments, emerging exposure, coverage concerns, and recommended strategies promptly to the client and management.
- Ensure assigned claims are handled in compliance with company procedures, client service instructions, applicable laws and regulations, and industry best practices.
- Serve as a senior technical resource and provide guidance to less-experienced claims examiners regarding coverage, public entity law, investigation, litigation management, claim valuation, and negotiation.
- Assist with peer file reviews, complex claim roundtables, training, quality-assurance initiatives, and process improvements as requested.
- Identify claim trends, recurring legal issues, and potential areas of client exposure and communicate observations and recommendations to management.
- Provide exceptional and responsive service to clients and other stakeholders.
- Perform other duties and special projects as assigned.
QUALIFICATIONS REQUIRED:
Education/Experience:
- High school diploma or GED required.
- Bachelor’s degree in business, insurance, risk management, criminal justice, or a related field preferred.
- A minimum of seven years of progressively responsible experience handling commercial automobile and general liability casualty claims required.
- At least five years of direct experience independently handling complex California public entity commercial automobile and general liability claims required.
- Significant experience handling litigated, high-exposure, catastrophic, and sensitive claims required.
- An equivalent combination of relevant education, professional training, and claims experience may be considered, provided the candidate possesses the required California public entity claims experience.
- At least five years of Automobile and General Liability California Public Entity claims experience required.
- Should reside in Sacramento, CA vicinity.
Licensure and Location:
- Current and valid California Independent Insurance Adjuster License required.
- Must maintain all licenses and continuing education requirements applicable to the position.
- Must reside in or near the Sacramento, California, area to support in-person client meetings, city council meetings, field investigations, site inspections, mediations, and other proceedings.
- Additional professional designations, such as AIC, ARM, CPCU, or SCLA, are preferred.
Knowledge, Skills, and Abilities:
- Advanced knowledge of California public entity claims laws, statutes, immunities, defenses, procedures, and claims-presentation requirements.
- Advanced knowledge of commercial automobile and general liability coverage claims investigation, litigation management, damages analysis, and claim valuation.
- Demonstrated ability to independently manage complex, high-exposure, catastrophic, and litigated claims with minimal supervision.
- Ability to interpret complex policy language, contracts, endorsements, indemnity provisions, and coverage requirements.
- Ability to recognize and evaluate potential subrogation, contribution, indemnification, additional insured, and other risk-transfer opportunities.
- Advanced analytical, critical-thinking, decision-making, negotiation, and problem-solving skills.
- Thorough understanding of the civil litigation process, including pleadings, discovery, depositions, expert testimony, mediation, settlement conferences, trial preparation, and legal budgeting.
- Demonstrated ability to develop and communicate effective litigation, reserve, and settlement strategies.
- Ability to effectively manage defense counsel, experts, investigators, and other outside service providers.
- Strong presentation skills and the ability to explain complex claim matters to clients, public agency representatives, management, and other stakeholders.
- Excellent verbal and written communication skills, including the ability to prepare clear and comprehensive loss reports.
- Ability to provide technical guidance, coaching, and constructive feedback to less experienced claims professionals.
- Strong organizational and time-management skills, with the ability to prioritize competing assignments and meet statutory, litigation, and client deadlines.
- Ability to exercise sound independent judgment and maintain confidentiality when handling sensitive matters.
- Proficiency with claims-management systems and standard business applications, including Microsoft Office.
- Demonstrated professionalism, initiative, adaptability, accountability, and commitment to client service.
MENTAL AND PHYSICAL REQUIREMENTS
- MENTAL EFFORT
a. Reasoning development:
- Follow one- or two-step instructions; routine, repetitive task.
- Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
- Follow written, verbal, or diagrammatic instructions; several concrete variables.
- Solve practical problems; variety of variables with limited standardization; interpret instructions.
- Logical or scientific thinking to solve problems; several abstract and concrete variables.
- Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
- Simple addition and subtraction; copying figures, counting, and recording.
- Add, subtract, multiply, and divide whole numbers.
- Arithmetic calculations involving fractions, decimals, and percentages.
- Arithmetic, algebraic, and geometric calculations.
- Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
- Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
- Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
- Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
- Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
- Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
-
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
-
PHYSICAL EFFORT
a. Physical activity required to perform the job:
- Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
- Light work:
- Exerting up to 20 pounds of force occasionally
- Exerting up to 10 pounds frequently
- Exerting a negligible amount of force constantly to move objects
- Medium work:
- Exerting up to 50 pounds of force occasionally
- Exerting up to 20 pounds of force frequently
- Exerting up to 10 pounds of force constantly to move objects
- Heavy work:
- Exerting up to 100 pounds of force occasionally
- Exerting up to 50 pounds of force frequently
- Exerting up to 20 pounds of force constantly to move objects
- Very heavy work:
- Exerting in excess of 100 pounds of force occasionally
- Exerting in excess of 50 pounds of force constantly to move objects
-
Exerting in excess of 20 pounds of force constantly to move objects
-
Visual requirements necessary to perform the job:
- Far vision: clarity of vision at 20 feet or more
- Near vision: clarity of vision at 20 inches or less
- Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
- Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
- Color vision: ability to identify and distinguish colors
-
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
-
Working Conditions
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
Position Summary: The Commercial Auto & General Liability Claims Examiner III independently manages a complex caseload of high-exposure California public entity commercial automobile and general liability claims, including litigated, catastrophic, and highly sensitive matters. The position is responsible for analyzing coverage, liability, damages, and legal issues; developing claim-resolution strategies; directing litigation and investigations; establishing appropriate reserves; and negotiating settlements within assigned authority.
This senior-level examiner serves as a technical resource to clients, management, and less-experienced claims professionals. The position maintains frequent contact with claimants, attorneys, defense counsel, experts, public agency representatives, and other parties involved. The Claims Examiner III provides clients with comprehensive recommendations regarding exposure, litigation strategy, reserves, settlement, and claim resolution. Position is remote/working from home.
DUTIES AND RESPONSIBILITIES:
- Independently investigate, analyze, evaluate, negotiate, and resolve complex, high-exposure commercial automobile and general liability claims.
- Manage litigated, catastrophic, sensitive, and technically complex California public entity claims from initial assignment through final resolution.
- Review and interpret policies, contracts, endorsements, coverage documents, client service instructions, and applicable laws to determine coverage and claim-handling obligations.
- Apply California public entity laws, statutes, immunities, defenses, procedures, and claims-presentation requirements to assigned matters.
- Identify and analyze complex issues involving liability, causation, damage, comparative negligence, immunities, indemnification, contribution, and risk transfer.
- Develop and implement comprehensive claim-action plans, litigation strategies, reserve recommendations, and settlement strategies.
- Establish and maintain timely, accurate, and well-supported reserves within assigned authority; promptly communicate significant exposure changes to the client and management.
- Evaluate settlement value and negotiate complex claims within delegated settlement authority.
- Prepare and present settlement recommendations for claims exceeding assigned authority.
- Direct and oversee defense counsel, investigators, appraisers, medical experts, engineers, accident-reconstruction specialists, and other outside service providers.
- Review and evaluate litigation plans, legal budgets, pleadings, discovery, expert reports, deposition testimony, and defense counsel recommendations.
- Monitor litigation progress, legal expenses, deadlines, and defense counsel performance to ensure matters are handled efficiently and in accordance with client expectations.
- Participate in mediations, mandatory settlement conferences, depositions, trials, and other legal proceedings when required.
- Conduct or coordinate field investigations and site inspections involving complex or high-exposure losses.
- Attend city council meetings, claim-review meetings, litigation strategy meetings, and client presentations in person when required.
- Prepare comprehensive loss reports addressing coverage, liability, damages, reserves, litigation strategy, settlement value, and recommended next steps.
- Present complex claim evaluations and recommendations clearly and professionally to clients, public agency representatives, management, and other stakeholders.
- Identify potential subrogation, contribution, contractual indemnity, additional insured, tender, or other risk-transfer opportunities and pursue recovery or transfer efforts at the client’s direction.
- Identify potential excess coverage, reinsurance, Medicare reporting, liens, statutory reporting, or other significant claim-related obligations and ensure timely escalation.
- Maintain complete, accurate, and timely claim-file documentation, including correspondence, evaluations, reports, negotiations, decisions, and action plans.
- Maintain an effective diary system and ensure that all claim activities, statutory deadlines, litigation dates, and client reporting requirements are completed timely.
- Communicate significant developments, emerging exposure, coverage concerns, and recommended strategies promptly to the client and management.
- Ensure assigned claims are handled in compliance with company procedures, client service instructions, applicable laws and regulations, and industry best practices.
- Serve as a senior technical resource and provide guidance to less-experienced claims examiners regarding coverage, public entity law, investigation, litigation management, claim valuation, and negotiation.
- Assist with peer file reviews, complex claim roundtables, training, quality-assurance initiatives, and process improvements as requested.
- Identify claim trends, recurring legal issues, and potential areas of client exposure and communicate observations and recommendations to management.
- Provide exceptional and responsive service to clients and other stakeholders.
- Perform other duties and special projects as assigned.
QUALIFICATIONS REQUIRED:
Education/Experience:
- High school diploma or GED required.
- Bachelor’s degree in business, insurance, risk management, criminal justice, or a related field preferred.
- A minimum of seven years of progressively responsible experience handling commercial automobile and general liability casualty claims required.
- At least five years of direct experience independently handling complex California public entity commercial automobile and general liability claims required.
- Significant experience handling litigated, high-exposure, catastrophic, and sensitive claims required.
- An equivalent combination of relevant education, professional training, and claims experience may be considered, provided the candidate possesses the required California public entity claims experience.
- At least five years of Automobile and General Liability California Public Entity claims experience required.
- Should reside in Sacramento, CA vicinity.
Licensure and Location:
- Current and valid California Independent Insurance Adjuster License required.
- Must maintain all licenses and continuing education requirements applicable to the position.
- Must reside in or near the Sacramento, California, area to support in-person client meetings, city council meetings, field investigations, site inspections, mediations, and other proceedings.
- Additional professional designations, such as AIC, ARM, CPCU, or SCLA, are preferred.
Knowledge, Skills, and Abilities:
- Advanced knowledge of California public entity claims laws, statutes, immunities, defenses, procedures, and claims-presentation requirements.
- Advanced knowledge of commercial automobile and general liability coverage claims investigation, litigation management, damages analysis, and claim valuation.
- Demonstrated ability to independently manage complex, high-exposure, catastrophic, and litigated claims with minimal supervision.
- Ability to interpret complex policy language, contracts, endorsements, indemnity provisions, and coverage requirements.
- Ability to recognize and evaluate potential subrogation, contribution, indemnification, additional insured, and other risk-transfer opportunities.
- Advanced analytical, critical-thinking, decision-making, negotiation, and problem-solving skills.
- Thorough understanding of the civil litigation process, including pleadings, discovery, depositions, expert testimony, mediation, settlement conferences, trial preparation, and legal budgeting.
- Demonstrated ability to develop and communicate effective litigation, reserve, and settlement strategies.
- Ability to effectively manage defense counsel, experts, investigators, and other outside service providers.
- Strong presentation skills and the ability to explain complex claim matters to clients, public agency representatives, management, and other stakeholders.
- Excellent verbal and written communication skills, including the ability to prepare clear and comprehensive loss reports.
- Ability to provide technical guidance, coaching, and constructive feedback to less experienced claims professionals.
- Strong organizational and time-management skills, with the ability to prioritize competing assignments and meet statutory, litigation, and client deadlines.
- Ability to exercise sound independent judgment and maintain confidentiality when handling sensitive matters.
- Proficiency with claims-management systems and standard business applications, including Microsoft Office.
- Demonstrated professionalism, initiative, adaptability, accountability, and commitment to client service.
MENTAL AND PHYSICAL REQUIREMENTS
- MENTAL EFFORT
a. Reasoning development:
- Follow one- or two-step instructions; routine, repetitive task.
- Carry out detail but uninvolved written or verbal instructions; deal with a few concrete variables.
- Follow written, verbal, or diagrammatic instructions; several concrete variables.
- Solve practical problems; variety of variables with limited standardization; interpret instructions.
- Logical or scientific thinking to solve problems; several abstract and concrete variables.
- Wide range of intellectual and practical problems; comprehend most obscure concepts.
b. Mathematical development:
- Simple addition and subtraction; copying figures, counting, and recording.
- Add, subtract, multiply, and divide whole numbers.
- Arithmetic calculations involving fractions, decimals, and percentages.
- Arithmetic, algebraic, and geometric calculations.
- Advanced mathematical and statistical techniques such as calculus, factor analysis, and probability determination.
- Highly complex mathematical and statistical techniques such as calculus, factor analysis, and probability determination; requires theoretical application.
c. Language development:
- Ability to understand and follow verbal or demonstrated instructions; write identifying information; request supplies verbally or in writing.
- Ability to file, post, and mail materials; copy data from one record to another; interview to obtain basic information such as age, occupation, and number of children; guide people and provide basic direction.
- Ability to transcribe dictation; make appointments and process mail; write form letters or routine correspondence; interpret written work instructions; interview job applicants.
- Ability to compose original correspondence, follow technical manuals, and have increased contact with people.
-
Ability to report, write, or edit articles for publication; prepare deeds, contracts or leases, prepare and deliver lectures; interview, counsel, or advise people; evaluate technical data.
-
PHYSICAL EFFORT
a. Physical activity required to perform the job:
- Sedentary work: Exerting up to 10 pounds of force occasionally and/or a negligible amount of force frequently or constantly to lift, carry, push, pull, or otherwise move objects. Sedentary work involves sitting most of the time. Jobs are sedentary if walking and standing are required only occasionally and all other sedentary criteria are met.
- Light work:
- Exerting up to 20 pounds of force occasionally
- Exerting up to 10 pounds frequently
- Exerting a negligible amount of force constantly to move objects
- Medium work:
- Exerting up to 50 pounds of force occasionally
- Exerting up to 20 pounds of force frequently
- Exerting up to 10 pounds of force constantly to move objects
- Heavy work:
- Exerting up to 100 pounds of force occasionally
- Exerting up to 50 pounds of force frequently
- Exerting up to 20 pounds of force constantly to move objects
- Very heavy work:
- Exerting in excess of 100 pounds of force occasionally
- Exerting in excess of 50 pounds of force constantly to move objects
-
Exerting in excess of 20 pounds of force constantly to move objects
-
Visual requirements necessary to perform the job:
- Far vision: clarity of vision at 20 feet or more
- Near vision: clarity of vision at 20 inches or less
- Mid-range vision: clarity of vision at distances of more than 20 inches and less than 20 feet
- Depth perception: the ability to judge distance and space relationships, so as to see objects where and as they actually are
- Color vision: ability to identify and distinguish colors
-
Field of vision: ability to observe an area up or down or to the right or left while eyes are fixed on a given point
-
Working Conditions
Disagreeable job conditions to which the employee may be exposed and the frequency (e.g., continually, frequently, or occasionally) of this exposure.
See all 294+ Medical Claims Examiner Jobs
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Get Access To All JobsTips for Finding Medical Claims Examiner Jobs
Highlight Healthcare Industry Knowledge
Emphasize your understanding of medical terminology, ICD-10 codes, and healthcare regulations. Employers need specialized knowledge to justify H-1B sponsorship for this analytical role.
Get Medical Coding Certifications
Obtain CCS, CPC, or RHIA certifications before applying. These credentials demonstrate the specialized skills employers use to support visa petitions for claims examiner positions.
Target Large Insurance Companies
Focus on major health insurers like Anthem, Aetna, and UnitedHealth. Large companies have established H-1B programs and regularly sponsor international candidates for specialized positions.
Emphasize Fraud Detection Skills
Highlight experience with claims fraud detection and pattern analysis. These specialized investigative skills help distinguish your role from general administrative work during USCIS review.
Document Quality Assurance Experience
Showcase experience reviewing claims accuracy and implementing quality control processes. This demonstrates the analytical complexity that supports specialty occupation classification under immigration law.
Consider Remote-Friendly Employers
Many insurance companies offer remote claims examiner positions. This expands your geographic options while targeting employers who already have H-1B sponsorship infrastructure in place.
Frequently Asked Questions
What degree do I need for H-1B sponsorship as a medical claims examiner?
You need a bachelor's degree in health administration, healthcare management, nursing, or a closely related field. Some employers accept business or finance degrees if combined with medical coding certifications like CCS or CPC. The key is demonstrating specialized healthcare knowledge that requires formal education beyond high school.
Do medical claims examiner positions qualify for H-1B specialty occupation requirements?
Yes, when the role requires specialized healthcare knowledge and a relevant bachelor's degree. Employers must demonstrate that the position involves complex medical claim analysis, fraud detection, or regulatory compliance that goes beyond routine administrative tasks. Medical coding certifications strengthen the specialty occupation argument.
Which employers are most likely to sponsor H-1B visas for claims examiners?
Large health insurance companies like UnitedHealth Group, Anthem, Aetna, and Cigna frequently sponsor H-1B visas. These companies have dedicated immigration teams and regularly hire international candidates for specialized healthcare roles. Third-party administrators and government contractors also offer sponsorship opportunities.
How to find Medical Claims Examiner jobs with visa sponsorship?
To find Medical Claims Examiner jobs with visa sponsorship, use Migrate Mate, which specializes in connecting international candidates with sponsored positions. Focus on healthcare organizations, insurance companies, and third-party administrators that frequently hire for these roles. H-1B and TN visas are commonly sponsored for Medical Claims Examiner positions, as these roles require specialized knowledge in medical coding and claims processing.
What's the H-1B approval rate for medical claims examiner positions?
USCIS doesn't publish role-specific approval rates, but healthcare administration positions generally have favorable outcomes when properly documented. The key factors are demonstrating specialty occupation requirements through degree field alignment, medical coding certifications, and detailed job duties that require specialized healthcare knowledge rather than general administrative skills.
Can I get H-1B sponsorship for remote medical claims examiner work?
Yes, many insurance companies sponsor H-1B visas for remote claims examiner positions. However, the Labor Condition Application must specify your work location, and you're restricted to that geographic area. If you need to relocate, your employer must file an amended LCA before you can work from the new location.
What is the prevailing wage requirement for sponsored Medical Claims Examiner 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.