Nurse Medical Claims Reviewer — Fraud Analytics (Remote)

Peraton; United States; Remote; USD 66,000 - 106,000; Full time

Benefits offered by this job

Telework from any state

Job summary

Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations.

Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years with a Bachelor's (or 3 years with a Master's, or 7 with an Associate), and demonstrate strong investigative, communication, and organizational skills.

Qualifications

• Required RN license in the US.
• Experience in medical claims review or coverage/medical necessity.
• Strong investigative, communication, and organizational skills.
• US citizenship required.

Responsibilities

• Conduct medical record reviews and apply clinical judgment to claim payments.
• Research Medicare claim data and other sources to identify issues and support investigations.
• Develop cases for legal action and coordinate with external agencies as needed.
• Telework available from any state.

Skills

Investigative skills

Communication

Organization

PC knowledge

Education

Bachelor's degree (5+ years)

Master's degree (3 years)

Associates degree (7 years)

Job description

Peraton’s SafeGuard Services seeks a Nurse Reviewer to conduct medical record reviews, applying clinical judgment to claim payments and supporting fraud investigations.

Telework is available from any state. The ideal candidate will hold a US nursing license, have 5+ years with a Bachelor's (or 3 years with a Master's, or 7 with an Associate), and demonstrate strong investigative, communication, and organizational skills.