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Claims Risk Manager Jobs in Virginia (NOW HIRING)

Kinsale Insurance

Claims Examiner

Richmond, VA

Bachelor's degree in Business, Risk Management, or a related field * 2+ years of experience handling commercial general liability claims involving bodily injury and property damage * Strong ...

Kinsale Insurance

Claims Examiner

Richmond, VA · On-site

Bachelor's degree in Business, Risk Management, or a related field * 2+ years of experience handling commercial general liability claims involving bodily injury and property damage * Strong ...

Corvel

Claims Specialist

Glen Allen, VA · Remote

$52K - $85K/yr

The Claims Specialist manages within company best practices low to mid Auto and/or General ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Claims Specialist

Glen Allen, VA · Remote

$52K - $85K/yr

The Workers' Compensation Claims Specialist manages within company best practices lower-level, non ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Claims Specialist

Glen Allen, VA · On-site

$52K - $85K/yr

The Claims Specialist manages within company best practices low to mid Auto and/or General ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Claims Specialist

Glen Allen, VA · On-site

$52K - $85K/yr

The Workers' Compensation Claims Specialist manages within company best practices lower-level, non ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Liability Claims Specialist

Glen Allen, VA · Remote

$52K - $85K/yr

The Liability Claims Specialist manages non-complex and non-problematic Heavy Auto and/or General ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Liability Claims Specialist

Glen Allen, VA · Remote

$52K - $85K/yr

The Liability Claims Specialist manages non-complex and non-problematic Liability claims under ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Liability Claims Specialist

Glen Allen, VA · On-site

$52K - $85K/yr

The Liability Claims Specialist manages non-complex and non-problematic Heavy Auto and/or General ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Medical Only Claims Specialist

Glen Allen, VA · On-site

$16.74 - $26.92/hr

Assists other claims professionals with more complex or problematic claims as necessary ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

Corvel

Medical Only Claims Specialist

Glen Allen, VA · Remote

$16.74 - $26.92/hr

The Workers' Compensation Medical Only Claims Specialist manages non-complex and non-problematic ... CorVel Careers | Opportunities in Risk Management In general, our opportunities will be posted for ...

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All JobsClaims Risk Manager JobsClaims Risk Manager Jobs in Virginia

Claims Risk Manager information

How does a Claims Risk Manager typically collaborate with other departments to minimize organizational risk?

A Claims Risk Manager works closely with departments such as underwriting, legal, compliance, and operations to identify potential risk exposures and implement effective mitigation strategies. They often participate in cross-functional meetings to review claims trends, share insights, and develop risk management policies. This collaborative approach ensures that the organization proactively addresses risks, maintains regulatory compliance, and continually improves claims processes for better outcomes.

What is the difference between Claims Risk Manager vs Claims Adjuster?

AspectClaims Risk ManagerClaims Adjuster
CredentialsTypically requires a bachelor’s degree in risk management, insurance, or related field; certifications like CPCU or ARM are commonRequires a high school diploma or bachelor’s degree; insurance licenses may be needed depending on state
Work EnvironmentOffice-based, strategic planning, risk assessment, policy developmentField or office-based, investigating claims, assessing damages, negotiating settlements
Industry UsageUsed across insurance companies, risk management firms, and large corporationsPrimarily in insurance companies, adjusting claims for auto, property, or health insurance

The Claims Risk Manager focuses on identifying and mitigating risks related to claims, developing policies, and overseeing risk strategies. In contrast, a Claims Adjuster handles the day-to-day investigation and settlement of individual claims. Both roles are essential in the insurance industry but differ in scope and responsibilities.

What are the key skills and qualifications needed to thrive as a Claims Risk Manager, and why are they important?

To thrive as a Claims Risk Manager, you need expertise in insurance claims processes, risk assessment, and regulatory compliance, typically backed by a bachelor’s degree in a relevant field and experience in claims management. Familiarity with claims management systems, risk modeling software, and certifications such as CPCU (Chartered Property Casualty Underwriter) or ARM (Associate in Risk Management) are often required. Strong analytical thinking, attention to detail, and effective communication skills help you investigate claims and collaborate with stakeholders. These skills enable accurate risk evaluation, minimize losses, and ensure the organization’s compliance and financial stability.

What does a Claims Risk Manager do?

A Claims Risk Manager is responsible for identifying, assessing, and managing risks associated with insurance claims within an organization. They analyze claims data to detect patterns, prevent fraudulent activity, and develop strategies to minimize financial losses. Additionally, they work closely with claims adjusters, legal teams, and other departments to ensure compliance with regulations and to optimize claims processes. Their goal is to protect the company from unnecessary losses while ensuring legitimate claims are handled efficiently.
What are popular job titles related to Claims Risk Manager jobs in Virginia? For Claims Risk Manager jobs in Virginia, the most frequently searched job titles are:
What job categories do people searching Claims Risk Manager jobs in Virginia look for? The top searched job categories for Claims Risk Manager jobs in Virginia are:
What cities in Virginia are hiring for Claims Risk Manager jobs? Cities in Virginia with the most Claims Risk Manager job openings:
Claims Risk Manager jobs near you
Director of Clinical Risk Management

Director of Clinical Risk Management

Old Dominion University

Norfolk, VA • On-site

Full-time

Posted 3 days ago

Old Dominion University rating

7.4

Company rating: 7.4 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

284th of 535 rated colleges and universities

Job description

Posting Details
Posting Details
Job Title
Director of Clinical Risk Management
Department
OFFICE OF RISK MANAGEMENT SS-VHS
Position Number
FP723A
Location
Norfolk, VA
Job Summary
The Director of Clinical Risk Management provides leadership and oversight of all clinical and operational risk management functions for the Elmer and Joan Brock Virginia Health Sciences at ODU (VHS), the EVMS Medical Group, and affiliated healthcare entities. Reporting to the Executive Director of Risk Management, this position assists in implementing and managing a comprehensive enterprise risk management (ERM) framework that integrates clinical, operational, financial, and reputational risk strategies across academic and clinical environments. The Director ensures healthcare-related risks are proactively identified, assessed, and mitigated; maintains compliance with accreditation and regulatory standards; and promotes a culture of patient safety and institutional accountability.
This position is required to complete a Statement of Personal Economic Interest upon hire in accordance with the Code of Virginia.
Position Type
FullTime
Type of Recruitment
General Public
Minimum Qualifications
Clinical Risk & Patient Safety Leadership
  • Expert-level understanding of clinical care processes, standards of care, patient safety science (human factors, high-reliability principles, just culture), diagnostic error, communication failures, transitions of care, medication safety, informed consent, documentation standards, and event prevention.
  • Ability to provide authoritative, real-time clinical risk guidance to physicians, APPs, nursing, and leadership during active events-balancing patient safety, ethical obligations, and liability exposure across diverse ambulatory and procedural settings.

Specialty-Specific Clinical Risk (Medical Group Practice)
  • Demonstrated knowledge of specialty-driven risk patterns and controls for:
  • OB/GYN: fetal monitoring, shoulder dystocia, postpartum hemorrhage, surgical consent, obstetric emergencies, high-risk pregnancy coordination.
  • Surgery & Procedural Practices (including ENT, Ophthalmology, Dermatology): wrong-site/wrong-procedure prevention, time-outs, specimen management, perioperative communications, sedation/airway considerations, post-op follow-up.
  • Radiation Oncology: treatment planning verification, dosing/field verification, safety time-outs, documentation of intent and consent, incident reporting pathways.
  • Psychiatry & Behavioral Sciences: suicide/self-harm risk assessment, involuntary holds, capacity/consent, duty to warn, documentation and continuity of care, boundary concerns.
  • Family & Community Medicine / PM&R: chronic disease management, diagnostic delay, care coordination, opioid/controlled substances risk, functional assessments, therapy/referral management.
  • Ability to translate these risks into standardized clinic protocols, training, and auditing.

Legal & Regulatory Compliance (Healthcare)
  • Advanced working knowledge of federal and state healthcare requirements and risk implications (HIPAA/privacy, documentation and record integrity, professional practice standards, scope-of-practice, mandated reporting, informed consent, telehealth considerations, EMTALA awareness when applicable, and patient rights).
  • Ability to partner with counsel to interpret requirements, set defensible clinical risk positions, and embed compliance into operational workflows.

Claims, Litigation, and Liability Exposure
  • Strong knowledge of professional liability/medical malpractice concepts: standard of care, causation, damages, documentation defensibility, disclosure and apology frameworks, privilege/peer review protections, claim lifecycle management, deposition preparation coordination, and insurer/TPA engagement.
  • Ability to oversee investigations with a "claims-ready" approach while prioritizing patient safety improvements.

Healthcare Operations & Systems
  • Deep familiarity with ambulatory and academic medical group operations, quality structures, credentialing/privileging concepts, interdepartmental workflows, emergency response pathways, patient grievances, and risk controls across clinical sites.
  • High proficiency with RMIS platforms (e.g., OrigamiRisk) and comfort leveraging EMR data for clinical event review, trend analysis, and corrective action monitoring.

Contracting, Risk Transfer, and Affiliation Governance
  • Advanced understanding of healthcare contracting risk (insurance requirements, indemnification, limitations of liability, clinical affiliation agreements, GME agreements, coverage for trainees, and third-party clinical services).
  • Ability to lead risk review and recommend contract language aligned with institutional risk tolerance and clinical realities.

Advanced Clinical and Risk Analysis
  • Ability to lead analysis of complex adverse events, near misses, patient complaints, and clinical claims; identify deviations from standards of care; evaluate documentation and communication quality; and determine priority mitigations.
  • Ability to produce clear, defensible executive summaries and recommendations tailored to clinical leaders.

Real-Time Consultative Leadership (High-Risk Events)
  • Ability to serve as the primary on-call/consultative risk leader for physicians, clinic administrators, nursing, and leadership during sentinel events and high-severity situations.
  • Ability to directs immediate response actions (care stabilization, escalation pathways, documentation guidance, preservation of evidence, and communication management) while coordinating with Patient Safety, Legal, Compliance, and insurers as needed.

Incident Investigation, RCA, and Corrective Action Governance
  • Ability to lead or chair RCAs and structured investigations; ensure consistent methodology; manages sensitive interviews; identifies system-level contributors; and drive sustainable corrective actions with defined owners, deadlines, metrics, and follow-up verification.

Disclosure, Communication, and Patient Relations Support
  • Ability to guide clinically appropriate disclosure processes and communication strategies with patients/families following adverse events, partnering with clinicians, patient relations, and counsel. Ability to ensure coordination of messaging, documentation standards, and follow-up planning.

Education, Training, and Culture of Safety Leadership
  • Ability to design and deliver targeted education to faculty, residents, fellows, and staff on patient safety, documentation, informed consent, escalation/reporting, and specialty-specific risk controls.
  • Ability to build a non-punitive learning environment that reinforces accountability, psychological safety, and continuous improvement.

Leadership, Influence, and Stakeholder Management
  • Demonstrated ability to lead across physician enterprise stakeholders (department chairs, clinic directors, practice administrators) and collaborate with senior executives.
  • Skilled in aligning diverse groups around risk priorities, establishing standards, and gaining adoption of practice changes.

Program and Project Management
  • Ability to set annual clinical risk management plans, priorities, and performance goals; manage multiple concurrent initiatives; oversee dashboards and reporting; and ensure timely execution across clinical departments and sites.

Enterprise Clinical Risk Strategy and Program Oversight
  • Ability to develop and execute a comprehensive clinical risk management program for a medical school and faculty medical group, including governance structures, standardized protocols, and performance monitoring across all clinical specialties and sites.

Prospective Risk Assessment & High-Reliability Methods
  • Ability to lead FMEA and other prospective risk assessments; identify high-risk clinical workflows; implement controls (standard work, checklists, time-outs, escalation triggers); and measure effectiveness over time.

Claims Prevention and Insurance/TPA Coordination
  • Ability partner with insurers/TPAs to manage claims exposure, support investigation strategy, improve documentation defensibility, and integrate claims learnings into safety improvements. Ability to ensure effective coordination with counsel and leadership while maintaining appropriate confidentiality and privilege.

Policy Development, Standardization, and Audit/Assurance
  • Ability to lead development/revision of clinical risk policies (event reporting, informed consent, documentation, chaperone policies, controlled substances practices, test result management, follow-up standards, procedural time-outs, radiation safety verification). Ability to establish audit mechanisms to verify adherence and reduce variation across clinics.

GME Oversight and Trainee Risk Controls
  • Ability to provide leadership for GME-related risk controls: resident supervision standards, escalation expectations, documentation practices, trainee onboarding/training, rotation agreements, and clear delineation of clinical responsibilities and coverage. Ability to coordinate with GME leadership on complex events and corrective actions.

Data-Driven Risk Trend Analytics and Reporting
  • Ability to build dashboards and executive reporting for trends in incidents, claims, patient complaints, specialty-specific events, and near misses. Ability to use data to set priorities, allocate resources, and target education and process improvements.

Regulatory Readiness and External Interface
  • Ability to support readiness for audits, reviews, and inquiries involving clinical risk issues; coordinates responses and documentation; and partner with compliance and counsel on regulatory reporting thresholds and institutional response.

Crisis Response and Sentinel Event Management
  • Ability to lead risk management response for high-severity events (wrong-site procedure, serious medication error, severe radiation dosing deviation, suicide attempt/self-harm event, severe OB outcomes). Ability to coordinate rapid mitigation, internal notifications, documentation expectations, and follow-up actions.

Clinical Contractual Risk Review and Risk Transfer
  • Ability to lead contract/affiliation review for clinical services and training arrangements; evaluates insurance and indemnification; recommend risk transfer strategies; and ensure agreements support clinical operations while protecting the institution.

Professional Judgment and Ethical Decision-Making
  • Ability to navigate ethically complex situations, competing priorities, and high-stakes decisions while maintaining integrity, confidentiality, and alignment with patient safety and organizational risk tolerance.

Relationship Management with Physician Leadership
  • Ability to partner effectively with department chairs and specialty leaders to implement standards, address practice variation, and resolve sensitive issues without undermining clinical autonomy.

Budget and Resource Planning
  • Ability to propose resource needs, justify investments (training, RMIS enhancements, audits), and manage program resources to achieve measurable safety and risk outcomes.
  • MBA, MPH, or other master's degree in a related field; or a Bachelor's degree in a related field with related experience equivalent to a master's degree.
  • Considerable progressively responsible experience in clinical risk management, including leadership roles.
  • Demonstrated expertise in clinical risk management, patient safety, and healthcare liability
  • Considerable knowledge of insurance management, risk financing principles, and regulatory compliance.
  • Strong leadership, analytical, and communication skills.

Preferred Qualifications
• Registered Nurse (RN) licensure preferred.
• JD or advanced degree in Nursing, Healthcare Administration, or related field strongly preferred.
• Certified Professional in Healthcare Risk Management (CPHRM) preferred.
Conditions of Employment
Job Open Date
05/07/2026
Open Until Filled
Yes
Application Review Date
05/25/2026
Job Close Date
Special Instructions to Applicants / Additional Materials Required
Criminal Background Check
The final candidate is required to complete a criminal history check.
Department Information
University Risk Management is serves as a trusted partner to the University community by overseeing the University's traditional risk management functions, including those supporting the Macon & Joan Brock Virginia Health Sciences at Old Dominion University. The department resides within the Office of Audit, Compliance, and Risk Management, and works collaboratively with University partners to advance loss prevention initiatives and manage claims and incidents.
Equity Statement
It is the policy of Old Dominion University to provide equal employment, educational and social opportunities for all persons, without regard to race (or traits historically associated with race including hair texture, hair type, and protective hairstyles such as braids, locks, and twists), color, religion, sex or gender (including pregnancy, childbirth, or related medical conditions), national origin, gender identity or expression, age, veteran status, disability, political affiliation, sexual orientation or genetic information. Individuals from minoritized communities, women, ve...

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