Insurance

• Educate consumers on Affordable Care Act (ACA) Marketplace health insurance options
• Assess individual and family coverage needs and explain available plan options
• Explain premiums, deductibles, copays, provider networks, prescription coverage, and other plan features
• Guide consumers through the ACA Marketplace application and enrollment process
• Provide professional, consultative customer service throughout consumer interactions
• Maintain accurate customer information, application details, and enrollment documentation in company systems
• Follow up with prospective and enrolled consumers as required
• Meet sales, conversion, quality, productivity, attendance, and customer experience expectations
• Maintain compliance with CMS, Marketplace, carrier, licensing, and company requirements
• Maintain required insurance licenses, certifications, carrier appointments, and Marketplace credentials
• Participate in ongoing training, coaching, performance development, and team meetings
• Navigate multiple computer systems and applications while assisting customers
• Perform additional duties as assigned

Licensed ACA Health Insurance Agent

• Lead process-level change control efforts
• Facilitate risk assessments for new or changing intent across multiple Card business areas
• Provide risk consulting, advice, and guidance to business areas
• Develop management reporting based on risk assessments
• Build stakeholder relationships and enable enterprise collaboration
• Deliver process frameworks within enterprise standards
• Coordinate process interactions and facilitate collaborative meetings with first- and second-line process participants
• Partner with data analysts to improve risk monitoring and reporting
• Synthesize data and perform analysis to generate business insights
• Design, implement, and influence internal governance processes
• Monitor systems of record for accuracy, quality, and consistency
• Provide stakeholder training
• Connect strategic and operational priorities to the changing risk environment
• Partner with risk advisors and the business to understand impacts
• Work with internal customers across all levels
• Identify and implement efficiencies and process improvements
• Self-manage, prioritize work, and deliver results
• Adapt to changing demands and divergent priorities

Principal Associate, Risk Management – US Card

• Lead risk, governance, and compliance management activities for High Priority Data, including High Priority Usages, Data Products, and Authoritative Sources
• Partner with data producers and consumers to drive timely data management, compliance, and governance activities
• Design, develop, and implement scalable routines, procedures, and repeatable processes for consistent enterprise HPU risk management
• Design, develop, and continuously improve Card data management controls
• Drive the process to evaluate control effectiveness in adherence with methodology
• Maintain a strategic view of the control environment while driving enhancements
• Build relationships and collaborate with key stakeholders
• Deliver key results and metrics across data management focus areas
• Partner with Card business teams and eData on data management tooling options

Manager, Risk Management – Card Data Management

• Support the FRM data risk lead for FPDS
• Provide risk advisory services to the Finance Divisional Data Risk Officer and various data and product teams
• Foster productive networks and relationships with Finance, business, and technology stakeholders
• Perform risk assessments against internal risk standards, including Enterprise Risk Management, Information and Data Management, and Technology Operations expectations
• Synthesize information from disparate sources to influence business, product, and technology leaders in risk-based decisions
• Identify themes to support the risk story
• Assist with audit and regulatory exam preparation and execution
• Champion process and controls improvements, including consideration of emerging technologies
• Identify opportunities to mature FRM practices and governance
• Provide risk education and stakeholder support as a risk subject matter expert
• Report on assigned work health to leadership
• Develop and maintain procedures and presentation materials

Senior Associate – Finance Risk Management, Tech and Data Risk

• Utilize data management metrics and insights to influence senior business leaders
• Apply data governance processes and controls to proactively mitigate risks
• Provide strategic program leadership and drive program alignment in a complex regulated environment
• Lead large-scale Risk Management Program Management/Governance
• Design, develop, and manage risk management-focused project plans
• Ensure projects are delivered on time and on budget while managing risk
• Communicate program requirements to internal and external stakeholders
• Partner cross-functionally to drive project delivery
• Report program status, risks, issues and decisions across the company
• Lead critical assessments on risk categories
• Build relationships with key stakeholders to deliver commitments
• Consult strategically with Accountable Executives and partner teams
• Problem-solve with cross-functional teams on issues and opportunities
• Design and drive a transformation vision
• Identify opportunities for continued business improvement
• Improve policies, processes, controls, and procedures
• Assist with audits and regulatory exams
• Coach and develop direct reports, extended team members and third-party resources

Senior Director, Card Risk Management

• Lead within the Risk Management Framework and Control Methodology team
• Architect and operationalize the project program roadmap
• Implement appropriate governance and drive progress across a complex, matrixed environment
• Lead a specialized reporting, insights, and GRC team
• Transform data into forward-leaning outcomes that influence decision-making
• Ensure business requirements are managed and implemented within reporting tools and GRC
• Empower and lead a high-performing team of risk professionals
• Manage complex, cross-functional projects, processes, and program integrations
• Build and maintain a detailed roadmap and develop project approaches
• Establish governance and tools such as project plans, RAID, and go-live requirements
• Champion project documentation and design standards to mitigate delivery risk
• Advance reporting and monitoring with tools providing real-time insights into risk framework and control methodology adherence
• Enhance GRC systems and integrate AI and automation into control management and testing protocols
• Build collaborative relationships and partner cross-functionally to drive delivery

Director, Risk Management

• Support Insurance Authorization Specialist I and Insurance Verification Specialist I staff
• Select accurate medical records for patient safety
• Obtain and validate demographic and insurance information
• Work with insurance companies and physician offices to complete authorization requirements and secure payment
• Ensure active and eligible insurance coverage
• Assist the department supervisor with daily workflow, workload distribution, escalated issues, and system/process issue tracking
• Serve as a subject matter expert and answer questions
• Mentor and train new team members
• Identify appropriate clinical records and submit authorization requests based on plan requirements
• Liaise between ordering physicians and insurance companies to identify and communicate approval requirements
• Help the team achieve quality, customer service, and productivity standards
• Perform other duties as assigned

Senior Insurance Authorization Specialist

• Obtain authorizations for elective infusions and injections to financially clear patients and ensure reimbursement
• Use payor resources and medical policies to verify prior authorization requirements
• Escalate financial clearance risks in compliance with the Financial Clearance Program
• Liaise between clinical teams and pharmacists regarding infusion prior authorization issues
• Code cases and review clinical documentation for completeness and maximum reimbursement
• Manage workloads and prioritize deadlines using EPIC work queues
• Collect and communicate outpatient benefit information to Patient Financial Services through Epic queues and billing indicators
• Refer to medical and coverage policies for medications and research CPT codes for drugs/injections
• Verify and submit authorizations through insurance portals, forms, or calls
• Review medical records to answer clinical authorization questions
• Communicate with clinics when additional information is needed
• Follow up on authorization requests, peer-to-peer reviews, and prior authorization appeals
• Communicate when home infusion or pharmacy benefits are needed
• Verify referrals and authorizations in work queues and identify medication dosing/frequency changes
• Assist with denial management and obtain retro authorizations
• Maintain Epic in baskets and Outlook emails
• Participate in monthly team meetings and one-on-ones
• Build admissions and submit authorizations for elective inpatient chemotherapy admissions and observations
• Follow workflows, report process deficiencies, maintain confidentiality, and communicate respectfully with staff, physicians, patients, families, and the public

Insurance jobs in Virginia