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Remote Insurance Utilization Review Jobs in Delaware

Liability Claims Specialist

Dover, DE · Remote

$52K - $85K/yr

This is a remote role. Candidate residing in the Mid-Atlantic Region is preferred. ESSENTIAL ... Adheres to client and carrier guidelines and participates in claims review as needed * Collaborates ...

Liability Claims Specialist

Dover, DE · Remote

$52K - $85K/yr

This is a remote role. Candidate residing in the Mid-Atlantic Region is preferred. ESSENTIAL ... Adheres to client and carrier guidelines and participates in claims review as needed * Collaborates ...

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Remote Insurance Utilization Review information

What is the difference between Remote Insurance Utilization Review vs Remote Claims Reviewer?

AspectRemote Insurance Utilization ReviewRemote Claims Reviewer
CredentialsTypically requires nursing or healthcare-related certifications, such as RN or licensed healthcare professionalUsually requires insurance or claims processing knowledge, sometimes with certifications like CPC or CPC-H
Work EnvironmentRemote, healthcare or insurance company settings, reviewing medical necessity and appropriateness of servicesRemote, insurance companies or third-party administrators, reviewing claims for accuracy and compliance
Industry UsageCommonly used in healthcare insurance to evaluate medical necessityUsed across insurance sectors to process and validate claims

Remote Insurance Utilization Review focuses on assessing the medical necessity of services, often requiring healthcare credentials. Remote Claims Reviewers handle claims processing and validation, emphasizing insurance knowledge. Both roles are remote and industry-specific but differ in their primary responsibilities and required qualifications.

How does a remote insurance utilization review professional collaborate with healthcare providers and insurance companies?

Remote insurance utilization review professionals regularly interact with healthcare providers to gather patient information, clarify treatment plans, and ensure that clinical documentation supports insurance requirements. They also communicate with insurance companies to advocate for patient care, provide necessary justifications, and resolve coverage issues. While the work is done remotely, collaboration typically occurs via secure email, phone calls, and virtual meetings, requiring strong communication and organizational skills to ensure timely and accurate exchange of information.

What are remote insurance utilization review jobs?

Remote insurance utilization review jobs involve evaluating medical records and treatment plans to determine whether healthcare services are medically necessary and covered by a patient’s insurance plan. Professionals in these roles, often nurses or other healthcare specialists, work from home and communicate with healthcare providers, insurance companies, and patients. Their main goal is to ensure that patients receive appropriate care while also helping insurance companies manage costs and comply with regulations.

What are the key skills and qualifications needed to thrive as a Remote Insurance Utilization Review Specialist, and why are they important?

To thrive as a Remote Insurance Utilization Review Specialist, you need a strong understanding of medical terminology, clinical guidelines, and insurance policies—usually supported by a nursing or health-related degree and relevant licensure. Familiarity with electronic medical record (EMR) systems, insurance claims platforms, and utilization review software is essential. Strong analytical skills, attention to detail, and effective written communication are crucial soft skills for this role. These competencies ensure accurate case evaluations, compliance with regulations, and clear communication between healthcare providers and insurers.
What cities in Delaware are hiring for Remote Insurance Utilization Review jobs? Cities in Delaware with the most Remote Insurance Utilization Review job openings:
Infographic showing various Remote Insurance Utilization Review job openings in Delaware as of June 2026, with employment types broken down into 67% Full Time, and 33% Part Time. Highlights an 100% Remote job distribution.

Liability Claims Specialist

Corvel

Dover, DE • Remote

$52K - $85K/yr

Full-time

Medical, Dental, Vision, Life, Retirement, PTO

Posted 5 days ago


CorVel rating

7.9

Company rating: 7.9 out of 10

Based on 50 frontline employees who took The Breakroom Quiz

82nd of 138 rated financial services


Job description

The Liability Claims Specialist manages non-complex and non-problematic Liability claims under direct supervision of a senior claims professional. This role aims to achieve optimal outcomes for both CorVel and our clients. The Liability Claims Specialist handles litigated files and works with delegated limited authority, adhering to company best practices.

This is a remote role.

Candidate residing in the Mid-Atlantic Region is preferred.

ESSENTIAL FUNCTIONS & RESPONSIBILITIES:

  • Manages non-complex and non-problematic medical only claims and minor lost-time liability claims under close supervision
  • Receives claims, confirms policy coverage and acknowledgment of the claim
  • Determines validity and compensability of the claim
  • Establishes reserves and authorizes payments within reserving authority limits
  • Communicates claim status with the customer, claimant, and client
  • Adheres to client and carrier guidelines and participates in claims review as needed
  • Collaborates with team members on more complex or problematic claims as necessary
  • Additional duties as assigned

KNOWLEDGE & SKILLS: 

  • Excellent written and verbal communication skills
  • Ability to learn rapidly to develop knowledge and understanding of claims practice
  • Ability to identify, analyze and solve problems
  • Computer proficiency and technical aptitude with the ability to utilize Microsoft Office including Excel spreadsheets
  • Strong interpersonal, time management, and organizational skills
  • Ability to meet or exceed performance expectations
  • Ability to work both independently and within a team environment

EDUCATION & EXPERIENCE: 

  • Minimum of 1 year of industry experience and claims management preferred
  • Bachelor's degree or a combination of education and related experience
  • Current Adjuster’s License in state of operation is required
  • Multi-State license is preferred

PAY RANGE:

CorVel uses a market based approach to pay and our salary ranges may vary depending on your location.  Pay rates are established taking into account the following factors:  federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions.  Our ranges may be modified at any time.

For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role.  The level may impact the salary range and these adjustments would be clarified during the offer process.

Pay Range:  $52,999 - $85,473

A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management

In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.

ABOUT CORVEL: 

CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients.  We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities.  Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). 

A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.

CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.

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