LTC Adjudication Specialist

2 months ago

Richmond, United States Genworth Full time

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
LTC Adjudication Specialist

POSITION LOCATION
This position is available to Virginia residents as Richmond or Lynchburg, Virginia 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’ll play a crucial role in delivering world class customer service and capabilities to our policyholders—now and in the future. As a LTC Adjudication Specialist, you will be responsible for the final determination of complex adjudication decisions whose outputs will have a positive impact on the management of claims risk across the Genworth product portfolio. The role is responsible for working directly with Long Term Care claims associates as the subject matter expert in adjudication handling escalation and resolution of risk decisions and complex claim problems. Additionally, you will participate in developing policies and practices, as well as providing ongoing training.

What you will be doing

  • Partnering directly with Long Term Care claims associates as the subject matter expert in adjudication handling escalation and resolution of risk decisions and complex claim problems

  • Review and final determination of complex adjudication decisions whose outputs will have a positive impact on the management of claims risk across the Genworth product portfolio

  • Participates in developing policies and practices providing ongoing training

  • Assisting in the development, documentation, and maintenance of Claims Standard Operating Procedures

  • Research, analysis, and communication of any changes to the Federal/State laws and regulations governing long-term care insurance and long-term care providers


What you bring

  • A high school diploma or military experience.

  • Must be able to interpret, understand and apply LTC policy language; Able to research, analyze and interpret complex state laws and supporting regulations, most specifically regarding the licensing of long-term care providers

  • Knowledge of long term care insurance and the Medicare and Medicaid systems. Knowledge of geriatric health care including long-term care, knowledge of anatomy, symptomology and physiology and how these translate to prognoses, diagnoses and treatment plans

  • Able to lead and/or participate in multiple projects from conceptualization through post implementation in addition to providing support to other business units with competing priorities

  • Superior written communication, facilitation and presentation skills

  • Works effectively in a team environment that presents a high degree of subjectivity and change

  • Superior customer service skills demonstrating diplomacy, clarity and influence in working with other areas of the business, vendors, policyholders and sales force

  • Integrates and accurately interprets risk management protocol in all decisions

  • Proven problem-solving and business analysis skills

  • Team oriented and flexible to change, particularly in an on-going change environment

  • Able to interact effectively with all associate levels, while maintaining professionalism

  • Good working knowledge of systems applications and analytical tools (e.g. WORD, EXCEL, PowerPoint, etc.)

Nice to have

  • Unique knowledge & skills typically acquired by experienced disability and/or worker compensation claims examiners specializing in LTC, LTD or ID claims, and/or 4-5 years of experience in an allied health profession, insurance industry, or legal background preferred

  • Bachelor’s degree or equivalent experience preferred

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 $49,700 up to the maximum of $91,500. 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.

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