Clinical Claims Review Nurse

Job not on LinkedIn

🔥 15 hours ago

🌾 North Dakota – Remote

🌾 North Dakota – Remote

💵 $26 - $68 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

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• Open for 1 day.
• Jobs at this company usually fill in 21 days.

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CVS Health Careers

WebsiteLinkedInAll Job Openings

10,000+ employees

🏥 Healthcare

🛒 Retail

📦 Logistics

Healthcare • Retail • Logistics

CVS Health Careers is the recruitment and employer branding arm of CVS Health, showcasing job opportunities across the company's broad operations—pharmacy retail stores, pharmacy services, health care clinics, distribution warehouses, corporate functions and transportation. The careers site emphasizes purpose-driven work focused on improving access, affordability and quality of health care, and highlights a large workforce (300,000+ employees), inclusive culture, benefits, and hiring resources for applicants.

📋 Description

• Review and interpret clinical documentation from medical records or systems • Apply clinical decision-making and appropriate clinical criteria and policies for post-service claims • Coordinate clinical resolutions independently, with clinician/MD support as required • Serve as a resource for customer service and claims processing teams • Train new staff and cross-train existing team members • Identify trends and provide feedback to leadership about discrepancies or potential fraudulent activities • Stay current with applicable laws, regulations, and internal workflows to ensure compliance with organizational and state-specific requirements

🎯 Requirements

• Nursing degree (RN) • Minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience • Strong analytical skills to assess medical claims • Direct/hardwired internet connection to a modem/router within 7 feet of the computer • Minimum internet speed of 50 Mbps download and 5 Mbps upload • Quiet, secure, private designated home workspace compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently living • Ability to use multiple monitors and navigate multiple applications • Ability to communicate via email, calendar invites, Teams messaging, and virtual meetings • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to access secure systems such as VPN and EHR portals • Ability to follow computer security practices, including locking screens, managing strong passwords, and recognizing suspicious emails or links • Ability to troubleshoot common technical issues independently • Openness to learning new skills as the workplace evolves

🏖️ Benefits

• Medical coverage • Dental coverage • Vision coverage • Paid time off • Retirement savings options • Wellness programs • Other resources supporting physical, emotional, and financial well-being • Company-provided equipment (keyboard, monitor, computer, headset, etc.) • CVS Health bonus, commission or short-term incentive program eligibility

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