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Remote Insurance Utilization Review Jobs in Springfield, VA

Loan Review Managing Consultant

Washington, DC · On-site +1

$113K - $188K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

Loan Review Senior Consultant

Washington, DC · On-site +1

$98K - $163K/yr

Reviewers may support onsite or remote reviews, participate in quality assurance activities, and ... Medical, Rx, Dental & Vision Insurance * Personal and Family Sick Time & Company Paid Holidays

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Remote Insurance Utilization Review information

See Springfield, VA salary details

$22

$44

$72

How much do remote insurance utilization review jobs pay per hour?

As of Jul 1, 2026, the average hourly pay for remote insurance utilization review in Springfield, VA is $44.16, according to ZipRecruiter salary data. Most workers in this role earn between $34.90 and $50.72 per hour, depending on experience, location, and employer.

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 job categories do people searching Remote Insurance Utilization Review jobs in Springfield, VA look for? The top searched job categories for Remote Insurance Utilization Review jobs in Springfield, VA are:
What cities near Springfield, VA are hiring for Remote Insurance Utilization Review jobs? Cities near Springfield, VA with the most Remote Insurance Utilization Review job openings:
Infographic showing various Remote Insurance Utilization Review job openings in Springfield, VA as of June 2026, with employment types broken down into 67% Full Time, 24% Part Time, 3% Temporary, 3% Contract, and 3% Nights. Highlights an 89% Physical, 3% Hybrid, and 8% Remote job distribution, with an average salary of $91,862 per year, or $44.2 per hour.

Loan Review Managing Consultant

Guidehouse

Washington, DC • On-site, Remote

$113K - $188K/yr

Full-time

Medical, Dental, Vision, Life, Retirement

Posted 5 days ago


Key responsibilities

  • Perform detailed reviews of SBA 7(a) and 504 loan files to assess compliance with SBA Loan Program Requirements.

  • Document findings in structured work papers and loan file review reports, outlining condition, criteria, cause, effect, and corrective action for identified issues.

  • Work directly with SBA Lenders under SBA direction to clarify documentation, resolve preliminary deficiencies, and ensure understanding of identified risks and requirements.


Guidehouse rating

7.5

Company rating: 7.5 out of 10

Based on 26 frontline employees who took The Breakroom Quiz

36th of 58 rated business consultants


Job description

Job Family:

Management Consulting


Travel Required:

Up to 10%


Clearance Required:

Ability to Obtain Public Trust

What You Will Do:

The Loan Review Managing Consultant will support the U.S. Small Business Administration (SBA) Office of Credit Risk Management (OCRM) by performing detailed reviews of 7(a) and 504 loan files as part of SBA's lender oversight and risk management activities. The role involves reviewing loan files across origination, servicing, liquidation, and targeted partial review scopes to assess compliance with SBA Loan Program Requirements as defined in 13 CFR Part 120 and applicable SBA Standard Operating Procedures (SOPs). The reviewer will analyze loan documentation, identify compliance issues or deficiencies, and document findings in structured work papers and loan file review reports.

The Loan Review Managing Consultant will inventory and analyze loan files, extract and evaluate data from SBA data systems and lender-provided documentation, and identify correctable and uncorrectable exceptions. The role includes working directly with SBA Lenders, under SBA direction, to clarify documentation, resolve preliminary deficiencies when possible, and ensure lenders understand identified risks and requirements. Reviewers will prepare clear, well-supported written summaries and draft and final loan file review reports that outline condition, criteria, cause, effect, and corrective action for identified issues.

The Loan Review Managing Consultant will use a secure, web-based virtual data warehouse and workflow tracking system to manage file reviews, maintain work papers, and support status reporting. The role requires adherence to strict quality, timeliness, documentation, and data security standards, including the protection of Personally Identifiable Information (PII) and confidential business information. Reviewers may support onsite or remote reviews, participate in quality assurance activities, and contribute to weekly, monthly, or ad hoc reporting provided to SBA.

What You Will Need:

  • U.S. Citizenship and ability to obtain and maintain a federal Public Trust.

  • Bachelor's Degree and Minimum of five (5) years of recent experience working with SBA 7(a) and/or 504 loans (e.g., as a third-party reviewer, examiner, auditor, underwriter, loan closer, or liquidation specialist); OR nine (9) years of relevant experience in lieu of degree.

  • Minimum of three (3) years of experience supervising teams and fostering staff professional development.

  • Demonstrated ability to train new team members on technical matters and delivery expectations.

  • Demonstrated experience reviewing loan files for compliance, risk, and adherence to regulatory and program requirements.

  • Working knowledge of SBA Loan Program Requirements, including 13 CFR Parts 103 and 120 and SBA SOPs related to origination, servicing, liquidation, and lender oversight.

  • Strong analytical skills with the ability to identify, document, and clearly explain loan file deficiencies and risks.

  • Experience preparing detailed work papers, loan file review reports, and written summaries that support defensible conclusions.

  • Ability to communicate effectively with SBA personnel and SBA Lenders, including explaining compliance issues and requirements.

  • Strong attention to detail, organization, and ability to manage multiple file reviews simultaneously while meeting delivery timelines.

  • Proficiency with document management systems, workflow tracking tools, and standard Microsoft Office applications (Excel, Word, PowerPoint).

What Would Be Nice To Have:

  • Direct experience supporting SBA Office of Credit Risk Management (OCRM) oversight activities, including risk-based reviews, examinations, audits, or increased supervision.

  • Experience performing servicing or liquidation reviews, including eligibility and disbursement testing.

  • Familiarity with quality assurance reviews, forensic reviews, or reviews related to fraud, waste, and abuse.

  • Experience working with virtual data warehouses, customer relationship management (CRM) systems, or management workflow systems (MWS).

  • Experience supporting federal financial regulatory or oversight programs beyond SBA.

  • Willingness and ability to support limited on-site reviews at SBA headquarters, SBA field offices, or SBA Lender locations, as required.

  • Ability to review loan files containing documentation in Spanish.

The annual salary range for this position is $113,000.00-$188,000.00. Compensation decisions depend on a wide range of factors, including but not limited to skill sets, experience and training, security clearances, licensure and certifications, and other business and organizational needs.


What We Offer:

Guidehouse offers a comprehensive, total rewards package that includes competitive compensation and a flexible benefits package that reflects our commitment to creating a diverse and supportive workplace.

Benefits include:

  • Medical, Rx, Dental & Vision Insurance

  • Personal and Family Sick Time & Company Paid Holidays

  • Position may be eligible for a discretionary variable incentive bonus

  • Parental Leave and Adoption Assistance

  • 401(k) Retirement Plan

  • Basic Life & Supplemental Life

  • Health Savings Account, Dental/Vision & Dependent Care Flexible Spending Accounts

  • Short-Term & Long-Term Disability

  • Student Loan PayDown

  • Tuition Reimbursement, Personal Development & Learning Opportunities

  • Skills Development & Certifications

  • Employee Referral Program

  • Corporate Sponsored Events & Community Outreach

  • Emergency Back-Up Childcare Program

  • Mobility Stipend

About Guidehouse

Guidehouse is an Equal Opportunity Employer-Protected Veterans, Individuals with Disabilities or any other basis protected by law, ordinance, or regulation.

Guidehouse will consider for employment qualified applicants with criminal histories in a manner consistent with the requirements of applicable law or ordinance including the Fair Chance Ordinance of Los Angeles and San Francisco.

If you have visited our website for information about employment opportunities, or to apply for a position, and you require an accommodation, please contact Guidehouse Recruiting at 1-571-633-1711 or via email at RecruitingAccommodation@guidehouse.com. All information you provide will be kept confidential and will be used only to the extent required to provide needed reasonable accommodation.

All communication regarding recruitment for a Guidehouse position will be sent from Guidehouse email domains including @guidehouse.com or guidehouse@myworkday.com. Correspondence received by an applicant from any other domain should be considered unauthorized and will not be honored by Guidehouse. Note that Guidehouse will never charge a fee or require a money transfer at any stage of the recruitment process and does not collect fees from educational institutions for participation in a recruitment event. Never provide your banking information to a third party purporting to need that information to proceed in the hiring process.

If any person or organization demands money related to a job opportunity with Guidehouse, please report the matter to Guidehouse's Ethics Hotline. If you want to check the validity of correspondence you have received, please contact recruiting@guidehouse.com. Guidehouse is not responsible for losses incurred (monetary or otherwise) from an applicant's dealings with unauthorized third parties.

Guidehouse does not accept unsolicited resumes through or from search firms or staffing agencies. All unsolicited resumes will be considered the property of Guidehouse and Guidehouse will not be obligated to pay a placement fee.


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