Remote RN Clinical Claims Reviewer

CVS Health

Topeka (KS)

Remote

USD 36,000 - 94,000

Full time

2 days ago

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Benefits offered by this job

Medical coverage

Dental & Vision

Paid time off

Retirement savings options

Wellness programs

Job summary

CVS Health in Topeka, KS is seeking a licensed RN to review and interpret clinical documentation for post‑service claims. The role requires applying criteria, coordinating resolutions with clinicians, and supporting customer service and claims teams.

The ideal candidate has 2–3 years of RN experience and strong analytical skills to assess medical claims, with adherence to CVS policies and HIPAA guidelines. This is a full‑time, work‑from‑home position with potential for growth and comprehensive

Qualifications

RN licensure and nursing degree required.
2–3 years of professional RN experience or equivalent clinical experience.
Strong analytic skills to assess medical claims.

Responsibilities

Review and interpret clinical documentation from medical records.
Apply clinical criteria and policies for post‑service claims.
Coordinate clinical resolutions with clinician/MD support as required.
Act as a resource for customer service and claims processing teams.
Train new staff and cross‑train existing team members.
Identify trends and report discrepancies or potential fraudulent activities to leadership.
Ensure compliance with applicable laws, regulations and CVS workflows.