Remote Clinical Claims Review RN

LeadingAge Virginia; Boston, Northern (MA, KY); Hybrid; USD 60,000 - 108,000; Full time

Job summary

UnitedHealth Group's Optum Insight is hiring a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation, identifying fraud, waste, and abuse in provider claims. The role requires travel within Massachusetts, remote work options, and collaboration with a small audit team.

You will review records, conduct site visits, and input audit findings into web-based templates, supporting client discussions and potential appeals.

Qualifications

• High School Diploma/GED or equivalent work experience.
• Nurse licensure (RN or LPN) with a current, active, and unrestricted license in Massachusetts.
• 2+ years of experience reviewing health care documentation in a clinical or administrative role.
• Proficiency with MS Word, PowerPoint, and Excel; basic data analysis.
• Ability to travel up to 25% of the time within Massachusetts.
• Full-time (40 hours/week); flexible 8-hour shifts; possible overtime.
• Must have a valid driver's license.
• Must be 18 years of age or older.

Responsibilities

• Review medical and administrative records for audit/compliance review.
• Travel to provider sites up to 25%/month to collect records and engage with providers.
• Present and participate in discussions with the client regarding audit observations and findings.
• Collaborate with a team of 2-5 auditors to complete reviews.
• Enter audit findings data and notes in online/electronic platform using Excel-based templates.
• Attend and participate in dispute reviews and administrative hearings.
• Demonstrated written and verbal communications skills.
• Demonstrated customer service skills.

Skills

Nurse licensure (RN/LPN)

MS Office Suite

Data analysis

Travel readiness

Education

High School Diploma/GED

Tools

Excel

Word

PowerPoint

Job description

UnitedHealth Group's Optum Insight is hiring a Clinical Claim Review RN to perform compliance reviews of medical and administrative documentation, identifying fraud, waste, and abuse in provider claims. The role requires travel within Massachusetts, remote work options, and collaboration with a small audit team.

You will review records, conduct site visits, and input audit findings into web-based templates, supporting client discussions and potential appeals.