Clinical Claims Review Nurse

Job not on LinkedIn

🔥 3 hours ago

🌾 North Dakota – Remote

🌾 North Dakota – Remote

💵 $29 - $62 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

👻 Ghost score 0%

What it means: the chance that no one is really hiring for this job.How to read it: 60% or higher means we think this is a ghost. Lower scores are less of a worry.How we score it: age, reposts, open roles vs team size, how fast jobs close, and whether pay is listed.Fine print: an estimate from public data, not a judgment of the company. Real jobs can score high, so treat it as a hint, not a fact.

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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 provide cross-training to existing team members • Identify trends and provide feedback to leadership regarding discrepancies or potential fraudulent activities • Stay current with applicable laws, regulations, and internal workflows • Ensure compliance with organizational and state-specific requirements

🎯 Requirements

• 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 • Minimum of an Associate’s Degree in Nursing or Diploma RN • Bachelor’s in Science & Nursing preferred • 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 work location compliant with CVS Health and HIPAA guidelines • Must work within the state and city where currently residing • Experience with Microsoft Office 365 applications or similar Google Workspace applications • Ability to navigate multiple monitors and applications • Ability to use email, calendar invites, Teams messaging, and virtual meetings • Ability to log in to secure systems such as VPN and EHR portals • Ability to manage strong passwords and recognize suspicious emails or links • Ability to troubleshoot common technical issues independently • Commitment to obtaining required internet speeds and following Work From Home requirements

🏖️ Benefits

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

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