Clinical Claims Review Nurse

We’re building a world of health around every individual — shaping a more connected, convenient and compassionate health experience. At CVS Health®, you’ll be surrounded by passionate colleagues who care deeply, innovate with purpose, hold ourselves accountable and prioritize safety and quality in everything we do. Join us and be part of something bigger – helping to simplify health care one person, one family and one community at a time.<br><br><strong>This role requires the nurse to exercise clinical judgment and perform the following duties:<br><br></strong><ul><li>Review and interpret clinical documentation obtained from medical records or systems.</li><li>Apply clinical decision-making to utilize appropriate clinical criteria and policies for post-service claims</li><li>Coordinate clinical resolutions independently, with clinician/MD support as required</li><li>Act as a resource for customer service and claims processing teams</li><li>Train new staff and provide cross-training to existing team members</li><li>Identify trends and provide feedback to leadership if discrepancies or potential fraudulent activities are identified</li><li>Remain current with applicable laws, regulations, and internal workflows to ensure full compliance with organizational and state-specific requirements<br><br></li></ul><strong>Required Qualifications<br><br></strong><ul><li>Must have active current and unrestricted Registered Nurse licensure in state of residence </li><li>Nursing degree (RN)</li><li>A minimum of 2–3 years of professional experience as a licensed Registered Nurse (RN), or equivalent clinical experience</li><li>Strong analytical skills to assess medical claims<br><br></li></ul><strong>Education<br><br></strong><ul><li>Bachelor's degree<br><br></li></ul><strong>Anticipated Weekly Hours<br><br></strong>40<br><br><strong>Time Type<br><br></strong>Full time<br><br><strong>Pay Range<br><br></strong><strong>The Typical Pay Range For This Role Is<br><br></strong>$26.01 - $68.55<br><br>This pay range represents the base hourly rate or base annual full-time salary for all positions in the job grade within which this position falls. The actual base salary offer will depend on a variety of factors including experience, education, geography and other relevant factors. This position is eligible for a CVS Health bonus, commission or short-term incentive program in addition to the base pay range listed above.<br><br>Our people fuel our future. Our teams reflect the customers, patients, members and communities we serve and we are committed to fostering a workplace where every colleague feels valued and that they belong.<br><br><strong>Great Benefits For Great People<br><br></strong>We take pride in offering a comprehensive and competitive mix of pay and benefits that reflects our commitment to our colleagues and their families.<br><br>This full‑time position is eligible for a comprehensive benefits package designed to support the physical, emotional, and financial well‑being of colleagues and their families. The benefits for this position include medical, dental, and vision coverage, paid time off, retirement savings options, wellness programs, and other resources, based on eligibility.<br><br>Additional details about available benefits are provided during the application process and on Benefits Moments.<br><br>We anticipate the application window for this opening will close on: 10/18/2026<br><br>Qualified applicants with arrest or conviction records will be considered for employment in accordance with all federal, state and local laws.

Back to blog

Other Jobs To Apply

Call Center Specialist [Work From Home - Night Shift - Full Time]

Call Center Agent (PT or FT - 100% Work From Home)

Excel Tutor – Part Time Remote Jobs

**Experienced Customer Support Representative – No Phone, Fully Flexible reputed company**

Long-haul Cabin Host-Atlanta,GA | Hiring

Software Engineer II, Backend (Batch Developer Experience)

Hiring for HEDIS - Data Engineer :: Remote

Gas Automation Engineer at Liberty Personnel Services, Inc. Goleta, CA

Call Center Agent (PT or FT - 100% Work From Home)

[Remote] Program Leader, Customer Advocacy Solutions Courier Experience

FULL TIME Remote Chat Support ? Beginner Level / No Phone Call /

Remote Freelance Translator: Malayalee or Egyptian

Amazon Content Moderator - Remote Position Available

Evening Part Time Remote Customer Support Speci…

Entry-Level Virtual Assistant Opportunity at Target: Administrative Excellence in a Dynamic Remote Setting

Business/Data Analyst - Entry Level

Experienced Part-Time Virtual Intern – College Student Opportunity in Remote Work Environment with The Elite Job

Amazon Fulfillment Center Jobs - Day And Night Shifts Open

Experienced Mothers Wanted to Help a Growing Family

Bilingual Mandarin Social Media Content Moderator

Virtual Data & Transcription Support Specialist (Part-Time | Full-Time)

[Remote-Position] Amex Virtual Assistant (Remote) ? The EliteJob

Splunk Solutions Engineer - South Africa

Watch And Tag Netflix Job @ Get Dream Job

Watch Netflix (Tagger): $12-$46

Urgently Hiring: [Part Time] Virtual Assistant Jobs No Experience

Watch Netflix (Tagger): $12-$46

Disney Work From Home Jobs Santa Fe, Disney Careers Jobs Apply In USA ( Operations Producer )

Amazon Remote Part-time jobs - Immediate Hiring Now

Watch Netflix (Tagger): $12-$46

Pediatrician – Urgent Care American Hospital Dubai

Remote Freight Operations Coordinator | Night Shift (EST)

Work From Home Jobs At Walmart $24/Hour

Global Brand Manager — Skincare Growth & Launch

Executive Secretary & Administrative Coordinator - Telework Eligible

Amazon Fulfillment Center - Order Picker

Flight Attendant at Southwest Airlines(Part-Time,Atlanta)

Remote Out of Office Position / Data Entry (Hiring Immediately)

Content Ingestion Assistant – Night Shift - Remote

Walgreens Jobs In USA (Remote Careers)

Delta Airlines Remote Customer Support - Work From Your Own Home

[Remote] QVC Customer Service Specialist - 2nd Shift

Fully Remote Position | Entry Level Leadership | No Experience Needed -Start ASAP

Junior Data Analyst/Data Scientist/Java Programmer - Remote

amazon work from home $15+/ Hour (Sign on Bonus!)!

Target At Home Jobs(Data Entry) $24/Hour

Experienced or Beginner Virtual Assistant for Teens - Make Money Online with Flexible Hours

reputed company Representative I (Entry Level/No Degree RQD) reputed company

Join Today: Chat Support Remote Agent (Part Time, Entry Level)

Third Shift Remote Customer Solutions Representative – Full‑Time Night‑Shift Role Specializing in Service Dispatch & Client Support