Remote RN Claims Reviewer

ISHE; Idaho; Remote; USD 36,000 - 94,000; Full time

Benefits offered by this job

Comprehensive benefits

Bonus eligibility

Remote work within state

Job summary

CVS Health is seeking a licensed RN to join our remote team focused on post-service claims review and clinical decision-making. You will interpret clinical documentation, apply policies, and coordinate resolutions with clinicians as needed.

The role requires 2–3 years of RN experience, strong analytical skills, and the ability to work remotely with verified home office setup. Eligible for CVS Health bonus and comprehensive benefits.

Qualifications

• Nursing degree (RN) required.
• 2–3 years of professional RN experience.
• Strong analytical skills to assess medical claims.

Responsibilities

• Review and interpret clinical documentation from medical records.
• Apply clinical decision-making to post-service claims.
• Coordinate clinical resolutions with clinician/MD support as required.
• Serve as resource for customer service and claims teams.
• Train new staff and provide cross-training to existing team members.
• Identify trends and report potential fraudulent activities to leadership.
• Stay compliant with applicable laws, regulations and internal workflows.

Skills

RN Nurse

Office 365

Education

RN degree

Tools

Microsoft Office 365

Job description

CVS Health is seeking a licensed RN to join our remote team focused on post-service claims review and clinical decision-making. You will interpret clinical documentation, apply policies, and coordinate resolutions with clinicians as needed.

The role requires 2–3 years of RN experience, strong analytical skills, and the ability to work remotely with verified home office setup. Eligible for CVS Health bonus and comprehensive benefits.