Claims Clinical Specialist
3 months ago
At Genworth, we empower families to navigate the aging journey with confidence. We are compassionate, experienced allies for those navigating care with guidance, products, and services that meet families where they are. Further, we are the spouses, children, siblings, friends, and neighbors of those that need care—and we bring those experiences with us to work in serving our millions of policyholders each day.
We apply that same compassion and empathy as we work with each other and our local communities, Genworth values all perspectives, characteristics, and experiences so that employees can bring their full, authentic selves to work to help each other and our company succeed. We celebrate our diversity and understand that being intentional about inclusion is the only way to create a sense of belonging for all associates. We also invest in the vitality of our local communities through grants from the Genworth Foundation, event sponsorships, and employee volunteerism.
Our four values guide our strategy, our decisions, and our interactions:
Make it human. We care about the people that make up our customers, colleagues, and communities.
Make it about others. We do what’s best for our customers and collaborate to drive progress.
Make it happen. We work with intention toward a common purpose and forge ways forward together.
Make it better. We create fulfilling purpose-driven careers by learning from the world and each other.
POSITION TITLE
Claims Clinical Specialist – Medical Review Team
POSITION LOCATION
This position is available to Virginia residents as Richmond or Lynchburg, VA Hybrid in-office applicants or remote applicants residing in states/locations under Eastern or Central Standard Time: Alabama, Arkansas, Connecticut, Delaware, Florida, Georgia, Illinois, Indiana, Iowa, Kansas, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Missouri, Nebraska, New Hampshire, New Jersey, New York, North Carolina, North Dakota, Ohio, Oklahoma, Pennsylvania, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Virginia, Washington DC, Vermont, West Virginia or Wisconsin.
YOUR ROLE
As an Operations team member, you will play a crucial role in delivering world class customer service and capabilities to our policyholders – now and in the future.
The Claims Clinical Specialist role is an excellent opportunity for a Registered Nurse seeking a career change. Bring your nursing knowledge and experience, and Genworth will provide the training necessary to succeed as a Medical Review Nurse. You will be responsible for improving our in-house certification functions by providing updates to the plan of care, in-house certifications, completing assessments, and monitoring low-risk claimants. This position will promote the provision of evidence-based, short-term case management services to long-term care insurance policyholders.
What you will be doing
You will be responsible for communicating with medical personnel at Long Term Care Facilities by conducting telephonic assessments for claimants to develop the plan of care and provide tax qualified certifications as required by the policy.
You will be responsible for obtaining information about the medical status and care needs of the insured to best understand the disease progression, ADL/IADL loss, and cognitive status.
You will be responsible for making decisions about the care need expectations and benefit eligibility of the insured as it aligns with specific policy requirements and the HIPAA regulations related to Tax Qualification Certification. You will be responsible for working within a structured environment with established Standard Operating Procedures to ensure consistency of claims practices.
You will be responsible for communication, teamwork and collaboration, and partnering with other teams or departments to achieve common goals and support continuous improvement initiatives.
You will be responsible for identifying, requesting, and analyzing pertinent medical records required to best understand the disease progression, ADL/IADL loss and potential for recovery.
You will identify process improvement opportunities, provide feedback on processes and case management model as well as be a critical team member in enhancing the team’s performance and results.
What you bring
Active Registered Nurse (RN) licensure
At least two years-experience working in a role that required an understanding of single and cumulative medical conditions (particularly those common in the aging process), including their effect on physical/cognitive function, as well as their prognosis and rehabilitative potential.
Able to understand and interpret MDS, Plan of Care, Physician Records and Occupational/Physical Therapist records and understand disease progression and recovery expectations.
Extraordinary internal and external customer service skills including patience, tactfulness, ability to remain calm and composed under pressure, effective listening skills, and professionalism.
Able to manage and prioritize a work queue and multiple job responsibilities.
You will be expected to have consistent, reliable, and predictable attendance to support the needs of the business.
Ability to understand and Interpret Insurance Contracts and Long-Term Care Benefits.
Good working knowledge of systems applications (e.g., WORD, EXCEL, PowerPoint, etc.).
Nice to Have
Bachelor’s Degree in Nursing, similar sciences, or higher postgraduate education
At least 2 years of medical experience with older adults and their families (hospital, nursing home, or community placements).
Experience in a Long -Term Care and/or Hospice setting
Strong knowledge of senior/geriatric/home health care, continuum of care, long-term care insurance and/or the Medicare program.
Geriatric medical knowledge.
Employee Benefits & Well-Being
Genworth employees make a difference in people’s lives every day. We’re committed to making a difference in our employees’ lives.
Competitive Compensation & Total Rewards Incentives
Comprehensive Healthcare Coverage
Multiple 401(k) Savings Plan Options
Auto Enrollment in Employer-Directed Retirement Account Feature (100% employer-funded)
Generous Paid Time Off – Including 12 Paid Holidays, Volunteer Time Off and Paid Family Leave
Disability, Life, and Long Term Care Insurance
Tuition Reimbursement, Student Loan Repayment and Training & Certification Support
Wellness support including gym membership reimbursement and Employee Assistance Program resources (work/life support, financial & legal management)
Caregiver and Mental Health Support Services
ADDITIONAL
The base salary pay range for this role starts at a minimum rate of $ 65,600 up to the maximum of $121,300. In addition to your base salary, you will also be eligible to participate in an incentive plan. The incentive plan is based on performance and the target earning opportunity is 7% of your base compensation. The final determination on base pay for this position will be based on multiple factors at the time of this job posting including but not limited to geographic location, experience, and qualifications to ensure pay equity within the organization.
-
Claims Resolution Specialist
1 week ago
Richmond, Texas, United States Medix Full timeMedix is seeking a Claims Resolution Specialist to join a prominent healthcare organization. This position offers a valuable opportunity for professional growth and development within the industry.Key Responsibilities:Assess denial reasons to ensure they are accurate and properly documented.Facilitate clinical consultations or refer accounts as...
-
Claims Support Specialist
5 days ago
Richmond, Virginia, United States RemX Full timeClaims Support SpecialistRemX is in search of a Claims Support Specialist to enhance their team. This role focuses on managing loss reports through various communication channels, including phone, email, and fax, utilizing an automated system.Handle incoming loss reports from clients via telephoneConfirm coverage and outline subsequent actionsPrioritize...
-
Senior Claims Examiner
2 weeks ago
Richmond, United States James River Management Company Full timeSenior Claims Examiner - Claims Specialist Alpharetta, GA, USA * Raleigh, NC, USA * Richmond, VA, USA * Scottsdale, AZ, USA * Virtual Req #127Wednesday, August 7, 2024Come grow with James River Insurance! James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved non-admitted basis in 50...
-
Claims Assessment Specialist
1 week ago
Richmond, Virginia, United States Insight Global Full timeJoin Insight Global as a Claims Experience Specialist!A prominent global travel insurance provider is seeking a dedicated Claims Experience Specialist to enhance their growing team. This essential role is centered around delivering exceptional claims services to valued clients, prioritizing a customer-focused approach. The hourly compensation ranges from $18...
-
Associate Claims Specialist
1 month ago
Richmond, United States Markel Full timeHandle minor non-litigated property damage and bodily injury claims with anticipated value of $25,000 or less in all jurisdictions. This position will be responsible for handling minor commercial general liability claims. Confirms coverage of claims Claims Specialist, General Liability, Associate, Claims, Liability, Specialist
-
Senior Claims Examiner
1 month ago
Richmond, United States James River Management Company Full timeSenior Claims Examiner - Claims Specialist - Construction DefectAlpharetta, GA, USA * Raleigh, NC, USA * Richmond, VA, USA * Scottsdale, AZ, USA * Virtual Req #118 Tuesday, June 25, 2024 Come grow with James River Insurance! James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and operates on an approved...
-
Senior Claims Examiner
1 month ago
Richmond, United States James River Management Company Full timeSenior Claims Examiner - Claims Specialist - Construction Defect Alpharetta, GA, USA * Raleigh, NC, USA * Richmond, VA, USA * Scottsdale, AZ, USA * Virtual Req #118 Tuesday, June 25, 2024 Come grow with James River Insurance! James River Insurance is an excess and surplus lines segment of James River Group Holdings, Ltd. and...
-
Richmond, Virginia, United States RemX Full timeCustomer Support Specialist for Claims ProcessingRemX is actively looking for a Customer Support Specialist focused on claims processing. This role is essential in managing incoming claims notifications from clients and ensuring high-quality assistance is delivered throughout the claims journey.Work Schedule:Initial Training: Standard business hours, Monday...
-
Insurance Claims Examiner
2 days ago
Richmond, Virginia, United States Selective Insurance Company of America Full timeJob Summary:We are seeking a highly motivated and detail-oriented Claims Resolution Specialist to join our team at Selective Insurance Company of America. As a Claims Resolution Specialist, you will be responsible for investigating, negotiating, and concluding small First Party or clear liability Third Party claims through effective communication and...
-
Primary Care Nurse Specialist
2 days ago
Richmond, Virginia, United States Specialist Office Full timeJob SummaryWe are seeking a highly skilled and experienced Primary Care Nurse Specialist to join our team at Specialist Office. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and support to our patients.Key ResponsibilitiesSupport the Healthcare TeamProvide clinical and administrative assistance to...
-
Travel Insurance Claims Analyst
1 week ago
Richmond, Virginia, United States Insight Global Full timeJoin Our Team as a Claims Experience SpecialistInsight Global, a prominent player in the travel insurance sector, is seeking a dedicated Claims Experience Specialist to enhance our dynamic team. This essential role is focused on delivering superior claims services to our esteemed clientele, emphasizing a commitment to customer satisfaction.Compensation: The...
-
Practical Nurse
4 days ago
Richmond, Virginia, United States Specialist Office Full timeJob OverviewPosition: Licensed Practical Nurse - Primary CareLocation: Specialist OfficeQualifications Required:Valid State of Virginia Nursing LicenseCurrent BLS/CPR CertificationExperience in Primary Care SettingsProficient in Phlebotomy and TriageAbility to Monitor Vital SignsIV Administration SkillsKey Responsibilities:Assist physicians with both...
-
Richmond, Virginia, United States Clinical Research Partners, LLC Full timeJob OverviewThe Quality Assurance Specialist (QAS) role is integral to the execution of Quality Assurance (QA) audit functions for designated studies, products, and vendors. This position is accountable for ensuring adherence to Good Clinical Practice (GCP) and/or Pharmacovigilance (PV) standards, while also ensuring compliance with the company's Standard...
-
Claims Processing Customer Support Agent
1 week ago
Richmond, Virginia, United States RemX Full timeJob OverviewRemX is excited to present an immediate opening for a Customer Support Agent specializing in Claims Processing.Work Schedule: Standard hours are from 9 am to 5 pm, Monday through Friday during the training phase. Post-training hours will adjust to 9:30 am to 5:30 pm, with a requirement to work four Saturdays annually.Initial Onsite Requirement:...
-
Auto Claims Customer Service
1 month ago
Richmond, United States Government Employees Insurance Company Full timeBilingual (Spanish) Claims SpecialistSalary: $22.33 per hour / $45,000 annually+10% Bilingual DifferentialClaim your career growth as a Bilingual Claims Service Specialist at GEICO’s Katy, TX office and be a part of one of the fastest-growing auto insurers in the United States! If you are motivated, all about solutions, and empathetic to the needs of...
-
Medical Care Coordinator
2 days ago
Richmond, Virginia, United States Specialist Office Full timeJob SummaryWe are seeking a highly skilled and experienced Primary Care Nurse Specialist to join our team at Specialist Office. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and support to our patients.Key ResponsibilitiesSupport the Physicians: Provide clinical and administrative assistance to our...
-
Richmond, Virginia, United States Elevateclaims Full timeAbout Elevate ClaimsElevate Claims is a leading provider of claims solutions, dedicated to delivering exceptional service and expertise to our clients.Job SummaryWe are seeking a highly skilled Large Loss Adjuster to join our team. As a Large Loss Adjuster, you will be responsible for handling complex property claims, providing expert appraisals, and working...
-
Medical Review Nurse
2 days ago
Richmond, Virginia, United States Genworth Full timeAbout the RoleAs a Clinical Claims Specialist on our Medical Review Team, you will play a crucial role in delivering exceptional customer service and capabilities to our policyholders. This is an excellent opportunity for a Registered Nurse seeking a career change, bringing your nursing knowledge and experience to Genworth.Key ResponsibilitiesCommunicate...
-
Licensed Practical Nurse LPN
2 days ago
Richmond, Virginia, United States Specialist Office Full timeJob SummaryWe are seeking a highly skilled and experienced Primary Care Nurse Specialist to join our team at Specialist Office. As a key member of our healthcare team, you will be responsible for providing high-quality patient care and support to our patients.Key ResponsibilitiesSupport the Physicians: Provide clinical and administrative assistance to our...
-
Licensed Practical Nurse
1 week ago
Richmond, Virginia, United States Specialist Office Full timeJob OverviewWe are seeking a dedicated Licensed Practical Nurse (LPN) to join our Specialist Office. This role is essential in delivering high-quality patient care and supporting our healthcare team.Key Qualifications:Active Virginia State Nursing LicenseCurrent BLS/CPR CertificationExperience in Primary Care SettingsProficient in Phlebotomy and...